The first reported case of corrected transposition with atrial inversion and normal hemodynamics is presented. The patient is an asymptomatic 10-year-old boy with a loud single second heart sound and a soft systolic ejection murmur at the base. The electrocardiogram reveals a P-wave vector directed to the right and inferiorly, suggesting atrial inversion. The presence of q waves in V4-6 suggests noninverted ventricles. Chest roentgenograms show dextrocardia, situs inversus, and a right aortic arch. Cardiac catheterization hemodynamic data reveal no evidence of a shunt or significant valvar abnormalities. On angiography the aortic valve lies to the right of the pulmonic valve and is more cephalad indicating D-transposition of the great arteries. The circulation is functionally completely corrected, since the systemic venous drainage enters the left-sided atrium and is ejected into the pulmonary artery by the left ventricle. The pulmonary venous drainage enters the right-sided atrium and is ejected into the transposed aorta by the right ventricle. A systematic approach to chamber localization is reviewed based upon: (1) the relationship of the viscera and atria (visceral atrial situs); (2) the relationship of the ventricles (type of bulboventricular loop); (3) the relationship of the great arteries.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine