PMC4007791_01
Chest X-ray of the lying patient in the a.p. path of ray. The congestion of the pulmonary veins reflects the cardiac shock and mild pulmonary edema. A meso-/dextrocardia with a dilated heart silhouette is the prominent finding.
CRIM.CARDIOLOGY2012-126764.001.jpg
PMC4007791_01_CRIM.CARDIOLOGY2012-126764.001.jpg
fig1
The chest X-ray demonstrated pulmonary vein stasis and a previously unknown meso-/dextrocardia with a dilated heart silhouette (Figure 1).
The aortic angiography performed during cardiac catheterisation confirms the dextrocardia and dextroposition of the aorta.
CRIM.CARDIOLOGY2012-126764.002.jpg
PMC4007791_01_CRIM.CARDIOLOGY2012-126764.002.jpg
fig2
T (0.020 ng/mL; reference value < 0.015 ng/mL) could be noticed, an indication for a coronary angiography was seen. This diagnostic procedure was technically demanding because of a dextroposition of the aorta (Figure 2).
The transthoracical echocardiography (here apical four-chamber view) demonstrates the in situ anatomy in L-TGA. Both ventricles changed their position. The right ventricle shows dilation, hypertrophy, and trabecularisation. The right atrioventricular valve is located closer to the apex compared with the left atrioventricular valve.
CRIM.CARDIOLOGY2012-126764.003.jpg
PMC4007791_01_CRIM.CARDIOLOGY2012-126764.003.jpg
fig3
Given the insufficient systemic bloodpressure, a bedside echocardiography was performed in order to exclude signs of acute right heart failure under the suspicion of a potential pulmonary embolism (Figure 3).
A schematic overview of the anatomical structures in this case of L-TGA is given.
CRIM.CARDIOLOGY2012-126764.004.jpg
PMC4007791_01_CRIM.CARDIOLOGY2012-126764.004.jpg
fig4
In a final step, cardiac magnetic resonance imaging (MRI) could confirm the echocardiographic findings and identified the underlying structural heart disease as a congenitally corrected transposition of the great arteries (L-TGA; schematic overview: see Figure 4).