Prenatal Diagnosis of Congenitally Corrected Transposition of the Great Arteries (CCTGA): A Case Report
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Abstract
CCTGA, also known as levo- or L-loop transposition (L-TGA), double discordance, or ventricular inversion, is a rare cardiovascular anomaly with inversion of the ventricles and great arteries. In this anomaly, the right atrium communicates with the morpho- logic left ventricle, which gives rise to the pulmonary artery, while the left atrium communicates with the morphologic right ventricle, which gives rise to the aorta. Thus, atrioventricular and ventriculoarterial discordance (double discordance) exist, and although the blood flows in the normal direction, it passes through the wrong ventricular chambers. It is a unique conotruncal anomaly, in which the four-chamber view is abnormal. It may be associated with other heart disorders. In most fetuses, TGA remains undiagnosed before birth. The diagnosis of TGA can be made by care- fully and appropriately evaluating the anatomic locations of cardiac chambers and the connections between the atria, ventricles, and great arteries with high-resolution ultrasound. Patients with isolated CTGA generally present later in life with signs and symptoms related to either arrhythmias or heart failure. TGA is rarely associated with chromosomal abnormality and amniocentesis is usually not undertaken. We report a case of CTGA detected at 18 week’s gestation on screening ultrasound.
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[9] Shih JC, Huang SC, Lin CH, Lin TH, Su YN, Lin SY, Wu ET, Shyn MK, Lee CN. Diagnosis of transposition of the great arteries in the fetus. Journal of Medical Ultrasound. 2021;20:65-71. https://doi.org/10.1016/j.jmu.2012.04.005
[10] de Oliveira RP, Agorianitis P, Vegni R, Nobre G, Kalichsztein M, Kezen J. Corrected transposition of great arteries: late clinical presentation, in the fifth decade of life. Arq Bras Car- diol. 2008;91(4):e43-e45. https://doi.org/10.1590/S0066- 782X2008001600015
[11] Bravo-Valenzuela N, Peixoto AB, Junior EA. Prenatal di- agnosis of congenitally corrected transposition of the great arteries. J Ultrasound. 2019;19:78:314-317. https://doi. org/10.15557%2FJoU.2019.0048
[12] Friedberg MK, Silverman NH, Moon-Grady AJ, Tong E, Nourse J, Sorenson B, Lee J, Hornberger LK. Prenatal detec- tion of congenital heart disease. 2009;155(1):26. https://doi. org/10.1016/j.jpeds.2009.01.050
[13] Krummholz A, Gottschalk I, Geipel A, Herberg U, Berg C, Gem- bruch U, Hellmund A. Prenatal diagnosis, associated findings and postnatal outcome in fetuses with congenitally corrected transposition of great arteries. Archives of Gynecology and Obstetrics. 2021;303:1469-1481. https://doi.org/10.1007/ s00404-020-05886-8
[14] McEwing RL, Chaoui R. Congenitally corrected transposition of the great arteries: clues for prenatal diagnosis. Ultrasound in Obstetrics and Gynecology. 2004;23(1):68-72. https://doi. org/10.1002/uog.896
[15] Verma S, Chidambaratanu S, Vijaylakshmi R, Srinivasan L, Suresh I. Apparent normal arrangement pattern of three-ves- sel view in a fetus with transposition of great arteries and L-malposed aorta. Ann Pediatr Cardiol. 2017;10(2):215-217. https://doi.org/10.1002/uog.11171
[16] Menahem S, Rotstein A, Meagher S. Rightward convexity of the great vessel arising from the anterior ventricle: A novel fe- tal marker for transposition of the great arteries. Ultrasound Obstet Gynecol. 2013;41:168-171. https://doi.org/10.1002/ uog.11171
[17] Ishii Y, Inamura N, Kawazu Y, Kayatani F, Arakawa H. ‘I-shaped’ sign in the upper mediastinum: A novel potential marker for antenatal diagnosis of d- transposition of the great arteries. Ultrasound Obstet Gynecol. 2013;41:667-671. https://doi. org/10.1002/uog.12312
[18] Mateos Laguna M, Gambacorti Passerini ZM, Leon Molina M, Calero Espino A, Marti Edo M, Bayoumy Delis BS, Anaya Baz MA, Sanchez Hipolito L. Down syndrome and transposition of great arteries. 17th World Congress in Fetal Medicine. Hospital General Universitario de Ciudad Real, Ciudad Real, Spain.
[19] Paladini D, Volpe P, Marasini M, Russo MG, Vassallo M, Gentile M, Calabro R. Diagnosis, characterization and outcome of congenitally corrected transposition of the great arteries in the fetus: a multicenter series of 30 cases. Ultrasound Obstet Gynecol. 2006;27(3):281-285. https://doi.org/10.1002/ uog.2715
[2] Ferencz C, Rubin JD, McCarter RJ, Neill CA, Perry LW, Hap- ner SI, Downing JW. Congenital heart disease: prevalence at livebirth. The Baltimore-Washington Infant Study. Am J Epidemiol. 1985;121(1):31. https://doi.org/10.1093/oxford- journals.aje.a113979
[3] Report of the New England Regional Infant Cardiac Program. Pediatrics. 1980;65(2 Pt 2):375. https://doi.org/10.1542/ peds.65.2.377
[4] Samanek M, Voriskova M. Congenital heart disease among 815,569 children born between 1980 and 1990 and their 15-year survival: a prospective Bohemia survival study. Pediatr Cardiol. 1999;20(6):411-417. https://doi.org/10.1007/s002469900502
[5] Kuehl KS, Loffredo CA. Population-based study of l-trans- position of the great arteries: possible associations with environmental factors. Birth Defects Res A Clin Mol Teratol. 2003;67(3):162-167. https://doi.org/10.1002/bdra.10015
[6] Becker TA, Van Amber R, Moller JH, Pierpont ME. Occurrence of cardiac malformations in relatives of children with transposition of the great arteries. Am J Med Genet. 1996;66(1):28. https:// doi.org/10.1002/(SICI)1096-8628(19961202)66:1<28::AID- AJMG7>3.0.CO;2-S
[7] Kutty S, Danford DA, Diller GP, Tutarel O. Response to: ‘Con- temporary management and outcomes in congenitallycorrected transposition of the great arteries’. Heart. 2018;104(14):1148- 1155. https://doi.org/10.1136/heartjnl-2016-311032
[8] Presbitero P, Somerville J, Rabajoli F, Stone S, Conte MR. Corrected transposition of great arteries without associat- ed defects in adult patients: clinical profile and follow up. Br Heart J. 1995;74:57-59. https://doi.org/10.1136/hrt.74.1.57
[9] Shih JC, Huang SC, Lin CH, Lin TH, Su YN, Lin SY, Wu ET, Shyn MK, Lee CN. Diagnosis of transposition of the great arteries in the fetus. Journal of Medical Ultrasound. 2021;20:65-71. https://doi.org/10.1016/j.jmu.2012.04.005
[10] de Oliveira RP, Agorianitis P, Vegni R, Nobre G, Kalichsztein M, Kezen J. Corrected transposition of great arteries: late clinical presentation, in the fifth decade of life. Arq Bras Car- diol. 2008;91(4):e43-e45. https://doi.org/10.1590/S0066- 782X2008001600015
[11] Bravo-Valenzuela N, Peixoto AB, Junior EA. Prenatal di- agnosis of congenitally corrected transposition of the great arteries. J Ultrasound. 2019;19:78:314-317. https://doi. org/10.15557%2FJoU.2019.0048
[12] Friedberg MK, Silverman NH, Moon-Grady AJ, Tong E, Nourse J, Sorenson B, Lee J, Hornberger LK. Prenatal detec- tion of congenital heart disease. 2009;155(1):26. https://doi. org/10.1016/j.jpeds.2009.01.050
[13] Krummholz A, Gottschalk I, Geipel A, Herberg U, Berg C, Gem- bruch U, Hellmund A. Prenatal diagnosis, associated findings and postnatal outcome in fetuses with congenitally corrected transposition of great arteries. Archives of Gynecology and Obstetrics. 2021;303:1469-1481. https://doi.org/10.1007/ s00404-020-05886-8
[14] McEwing RL, Chaoui R. Congenitally corrected transposition of the great arteries: clues for prenatal diagnosis. Ultrasound in Obstetrics and Gynecology. 2004;23(1):68-72. https://doi. org/10.1002/uog.896
[15] Verma S, Chidambaratanu S, Vijaylakshmi R, Srinivasan L, Suresh I. Apparent normal arrangement pattern of three-ves- sel view in a fetus with transposition of great arteries and L-malposed aorta. Ann Pediatr Cardiol. 2017;10(2):215-217. https://doi.org/10.1002/uog.11171
[16] Menahem S, Rotstein A, Meagher S. Rightward convexity of the great vessel arising from the anterior ventricle: A novel fe- tal marker for transposition of the great arteries. Ultrasound Obstet Gynecol. 2013;41:168-171. https://doi.org/10.1002/ uog.11171
[17] Ishii Y, Inamura N, Kawazu Y, Kayatani F, Arakawa H. ‘I-shaped’ sign in the upper mediastinum: A novel potential marker for antenatal diagnosis of d- transposition of the great arteries. Ultrasound Obstet Gynecol. 2013;41:667-671. https://doi. org/10.1002/uog.12312
[18] Mateos Laguna M, Gambacorti Passerini ZM, Leon Molina M, Calero Espino A, Marti Edo M, Bayoumy Delis BS, Anaya Baz MA, Sanchez Hipolito L. Down syndrome and transposition of great arteries. 17th World Congress in Fetal Medicine. Hospital General Universitario de Ciudad Real, Ciudad Real, Spain.
[19] Paladini D, Volpe P, Marasini M, Russo MG, Vassallo M, Gentile M, Calabro R. Diagnosis, characterization and outcome of congenitally corrected transposition of the great arteries in the fetus: a multicenter series of 30 cases. Ultrasound Obstet Gynecol. 2006;27(3):281-285. https://doi.org/10.1002/ uog.2715
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| Issue | Vol 7 No 3 (2022): May-June | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/crcp.v7i3.11119 | |
| Keywords | ||
| Corrected transposition of great arteries (CTGA) VSD Congenital heart disease (CHD) Prenatal diagnosis | ||
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How to Cite
1.
Hematian N, Torabi S, Hantoushzadeh S, Saleh M, Saleh M. Prenatal Diagnosis of Congenitally Corrected Transposition of the Great Arteries (CCTGA): A Case Report. CRCP. 2022;7(3):109-116.
