Transposition of the Great Arteries

  • Michael Hofbeck
  • Karl-Heinz Deeg
  • Thomas Rupprecht
Chapter
First Online:

Abstract

Transposition of the great arteries is a cardiac malformation, which is characterized by ventriculoarterial discordance. It is easily diagnosed by 2D echo in the precordial and subcostal views, confirming origin of the aorta from the morphologic right and of the pulmonary artery from the morphologic left ventricle. In the majority of cases, transposition of the great arteries is associated with concordant connections of the atria and ventricles. Colour Doppler echocardiography in neonates is essential to visualize shunting between both circulations across the atrial septum and the ductus arteriosus. It is also important in the search for ventricular septal defects, obstruction of the left and right ventricular outflow tract as well as possible obstruction of the aortic arch. PW and CW Doppler can be applied to document flow across an associated VSD, to quantify gradients across the outflow tracts and to assess flow across the aortic arch and ductus arteriosus.

Keywords

Ventriculoarterial discordance Atrioventricular discordance Transposition of the great arteries Congenitally corrected transposition 
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Supplementary material

318084_1_En_15_MOESM1_ESM.mp4 (492 kb)
Video 15.1 The parasternal long-axis view in a newborn with transposition of the great arteries shows origin of a great artery from the left ventricle. This view does not reveal the ventriculoarterial discordance (AVI 8764 kb)
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Video 15.2 Colour Doppler reveals unobstructed flow from the left ventricle to the transposed pulmonary artery (same patient as in Video 15.1) (AVI 1451 kb)
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Video 15.3 A further cranial plane reveals parallel course of the anterior aorta and posterior pulmonary artery in another newborn with transposition of the great arteries (AVI 6130 kb)
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Video 15.4 This clip in a newborn with transposition is obtained by cranial angulation of the transducer starting in the parasternal long-axis view of the left ventricle. It shows transition of the anterior vessel, which originates from the right ventricle, to the aortic arch confirming the diagnosis of transposition of the great arteries. Note the perimembranous VSD located underneath the pulmonary valve (AVI 25015 kb)
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Video 15.5 The apical four-chamber view in a newborn with transposition of the great arteries shows normal anatomy of the ventricles (AVI 7496 kb)
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Video 15.6 Colour Doppler in a more anterior plane (apical five-chamber view) shows a great artery originating from the left ventricle (same patient as in Video 15.6) (AVI 1362 kb)
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Video 15.7 Further anterior tilt of the transducer reveals a second great artery (aorta) originating from the right ventricle and taking a parallel course to the pulmonary artery that originates from the left ventricle (same patient as in Videos 15.6 and 15.7) (AVI 1423 kb)
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Video 15.8 The high parasternal short-axis view in a neonate with transposition of the great arteries reveals the dextroposed and anterior aorta in cross section, while the pulmonary artery and the pulmonary bifurcation are located posterior and to the left (AVI 5956 kb)
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Video 15.9 Colour Doppler (same patient as in Video 15.8) reveals unobstructed flow in the pulmonary bifurcation. The vessel displayed anterior to the right pulmonary in cross section is the superior vena cava ( (AVI 1778 kb)
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Video 15.10 The parasternal short-axis view at the level of the great arteries shows the anterior and dextroposed aorta. The aortic sinuses facing the pulmonary artery are termed sinus 1 and sinus 2; the sinus without contact to the pulmonary artery (non-facing sinus) is termed sinus 3 (see also Fig. 15.6) (AVI 4809 kb)
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Video 15.11 The high parasternal short-axis view in this neonate with transposition of the great arteries shows anteroposterior position of the aorta and pulmonary artery (AVI 20674 kb)
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Video 15.12 This slightly oblique parasternal short-axis view in a newborn with transposition of the great arteries visualizes origin of the right coronary artery from the aorta. Note the ectopic cranial origin of this coronary artery just above the sinotubular junction (AVI 16235 kb)
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Video 15.13 The parasternal short-axis view displays the anteroposterior position of the great arteries and the facing sinuses of the aorta in a newborn with transposition of the great arteries. Note that both coronary arteries originate in close proximity from sinus 2 of the aorta. The left coronary artery takes an intramural course between the great arteries to reach the left ventricle (AVI 17305 kb)
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Video 15.14 The ductal view in a neonate shows a large ductus arteriosus connecting the aorta and pulmonary artery. Note the fibrous shelf at the pulmonary end of the ductus (AVI 17882 kb)
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Video 15.15 Obstruction of the pulmonary end of the ductus by the fibrous shelf is confirmed by colour Doppler interrogation (same patient as in Video 15.14) (AVI 3905 kb)
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Video 15.16 Colour Doppler in the ductal view of this newborn with transposition of the great arteries shows significant hypoplasia of the distal aortic arch. Note that in the presence of a widely patent ductus arteriosus, there is no acceleration of flow in the distal aortic arch and aortic isthmus (AVI 2253 kb)
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Video 15.17 The ductal view in another newborn with transposition shows severe preductal isthmic coarctation with a fibrous shelf distal to the left subclavian artery and just proximal to the widely patent ductus arteriosus (AVI 7924 kb)
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Video 15.18 Colour Doppler (same patient as in Video 15.17) shows absence of turbulent flow in the distal aortic arch due to the presence of the widely patent ductus arteriosus. Due to the isthmic coarctation, flow from the distal aortic arch is oriented anteriorly towards the ductus arteriosus (AVI 2020 kb)
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Video 15.19 Colour Doppler in the subcostal coronal view of the atrial septum in a neonate with transposition of the great arteries shows a restrictive foramen ovale with left to right shunting (AVI 4021 kb)
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Video 15.20 This video clip in a slightly oblique subcostal coronal view from a newborn with transposition of the great arteries shows how a Rashkind balloon is advanced from the inferior vena cava to the right atrium and passing the foramen ovale to enter the left atrium (AVI 25062 kb)
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Video 15.21 This sequence in the subcostal coronal view shows how the inflated Rashkind balloon is retracted from the left atrium to the right atrium (same patient as in Video 15.20) (AVI 24939 kb)
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Video 15.22 The subcostal coronal view in a newborn with transposition of the great arteries shows origin of the pulmonary artery from the left ventricle (AVI 5342 kb)
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Video 15.23 Colour Doppler confirms unobstructed flow from the left ventricle to the pulmonary artery (same patient as in Video 15.22). Retrograde flow in the pulmonary bifurcation is due to a patent ductus arteriosus (AVI 2426 kb)
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Video 15.24 The video clip in the subcostal coronal view of a neonate with transposition of the great arteries starts in a posterior plane depicting origin of the pulmonary artery from the left ventricle. Anterior sweep of the transducer depicts origin of the aorta from the right ventricle. Note the parallel course of the great arteries (AVI 20218 kb)
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Video 15.25 Colour Doppler following some clockwise rotation of the transducer from the coronal view nicely depicts the parallel orientation of the great arteries in a newborn with transposition of the great arteries (AVI 2421 kb)
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Video 15.26 The slightly oblique subcostal coronal view in this newborn with transposition depicts parallel course of the great vessels and a large VSD that is located underneath the pulmonary valve (AVI 9476 kb)
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Video 15.27 Colour Doppler in the subcostal sagittal (short axis) view in this newborn with transposition of the great arteries shows discrepancy in size between the smaller anterior aorta and large posterior pulmonary artery (AVI 2651 kb)
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Video 15.28 The apical four-chamber view in a newborn with congenitally corrected transposition shows connection of the right atrium with a morphologic left ventricle and connection of the left atrium with a morphologic right ventricle. The morphologic right ventricle is characterized by the moderator band in the apex and more apical insertion of its respective atrioventricular valve (left-sided tricuspid valve). In addition the patient has a large perimembranous inlet ventricular septal defect (AVI 17952 kb)
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Video 15.29 Colour Doppler in the apical four-chamber view (same patient as in Video 15.28) reveals moderate regurgitation of the left-sided systemic tricuspid valve (AVI 1920 kb)
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Video 15.30 This video sequence from a child with congenitally corrected transposition shows a sweep in a high parasternal long-axis view starting from the pulmonary artery, which originates posteriorly from the left ventricle. Leftward tilt of the transducer displays the anterior aorta and its transition to the aortic arch. Note the parallel course of both vessels (AVI 38670 kb)
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Video 15.31 The high parasternal short-axis view in a child with congenitally corrected transposition (same patient as in Video 15.30) displays the transposed aorta in an anterior and leftward position (AVI 7577 kb)
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Video 15.32 The subcostal coronal view in a child with congenitally corrected transposition shows posterior origin of the pulmonary artery from the right-sided left ventricle. The pulmonary valve is stenotic. The aorta originates in a left anterior position from the left-sided right ventricle. Both ventricles are connected by a large VSD (AVI 5661 kb)
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Video 15.33 The subcostal coronal view in a neonate with congenitally corrected transposition reveals mesocardia. The pulmonary artery originates from the left ventricle and exhibits subvalvular and valvular stenosis. The aorta originates in a left anterior position from the ventricle. The patient has a large perimembranous VSD (AVI 16418 kb)
318084_1_En_15_MOESM34_ESM.mp4 (402 kb)
Video 15.34 Colour Doppler in the subcostal coronal view confirms severe obstruction of the pulmonary outlet (same patient as in Video 15.33) (AVI 2429 kb)
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Video 15.35 Colour Doppler in the subcostal coronal view of a newborn with transposition of the great arteries reveals obstruction of flow from the left ventricle to the transposed pulmonary artery due to pulmonary valve stenosis. The connection of the right ventricle to the aorta appears with obstruction (AVI 1120 kb)

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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Michael Hofbeck
    • 1
  • Karl-Heinz Deeg
    • 2
  • Thomas Rupprecht
    • 3
  1. 1.Universitätskinderklinik Tübingen Abt. KinderkardiologieTübingenGermany
  2. 2.Pediatric Clinic of the Sozialstiftung BambergBambergGermany
  3. 3.Klinikum Bayreuth GmbH Klinik für Kinderheilkunde/JugendmedizinBayreuthGermany

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