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(Circulation. 1998;97:1207.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Anatomically Corrected Malposition of the Great Arteries {S,D,L}

E.D. Blume, MD; T. Chung, MD; F.A. Hoffer, MD; ; T. Geva, MD

From the Departments of Cardiology (E.D.B., T.G.) and Radiology (T.C., F.A.H.), Children's Hospital, and the Departments of Pediatrics (E.D.B., T.G.) and Radiology (T.C., F.A.H.), Harvard Medical School, Boston, Mass.

Correspondence to Tal Geva, MD, Department of Cardiology, Children's Hospital, 300 Longwood Ave, Boston, MA 02115. E-mail geva_t@a1.tch.harvard.edu

B.M. is a previously healthy 18-year-old man referred for a second opinion on an abnormal echocardiogram. He had been followed in the first year of life for a nonspecific murmur. He presented again to medical attention secondary to Navy prequalification requirements and was referred to a local cardiologist. His physical examination, chest radiograph, and ECG were normal. On transthoracic and transesophageal echocardiograms performed in the referring institution, "the aorta did not connect to the left ventricle" and the superior aspect of the ventricular septum was "prominent." Cardiac MRI revealed levocardia with visceroatrial situs solitus and D-ventricular loop. The great arteries originated above the appropriate ventricles (ventriculoarterial concordance) (Fig 1), but their spatial position and orientation were abnormal: the aortic valve was anterior, superior, and leftward relative to the pulmonary valve and the great vessels were side-by-side (Figs 1 and 2). There was bilateral conus with aortic-mitral and pulmonary-tricuspid discontinuity and a well-developed subaortic chamber without obstruction. The patient had normal coronary anatomy and normal ventricular function.

View larger version (147K): [in this window] [in a new window]   Figure 1. Coronal T1-weighted MRI of chest demonstrates levocardia, atrial situs solitus, D-ventricular loop, and L-malposition of aorta with ventriculoarterial concordance. Aorta (AO) and main pulmonary artery (PA) arise above appropriate ventricles, but aortic valve is anterior, superior, and leftward relative to pulmonary valve and is supported by a conus. This image demonstrates unobstructed left ventricular outflow tract. LV indicates left ventricle; RA, right atrium; R, right; and S, superior.

View larger version (124K): [in this window] [in a new window]   Figure 2. Transverse T1-weighted MRI of chest at level of aortic (AO) . . . [Full Text of this Article]

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