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    Go to the top of the page   ID: 20030616161230 Original case in english  More links about this topic on Pubmed (PubMed Reader)
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    | The Authors | Discussion | Write a Comment to this Case |
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    Transposition of great arteries (TGA)
    H Eberhardt, S Kallsen. Transposition of great arteries (TGA). PedRad [serial online] vol 3, no. 6.
    URL: www.PedRad.info/?search=20030616161230


     
     Pediatric Radiology CasesImages to this case: There are Ultrasound-images available for this case. [ Ultrasound ] There are Pathology-images available for this case. [ Pathology ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    H. Eberhardt (Marburg), S. Kallsen (Landshut)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    Newborn  

     
     Pediatric Radiology CasesGender:

    N/A  

     
     Pediatric Radiology CasesRegion-Organ:

    Thorax-Heart  

     
     Pediatric Radiology CasesMost likely etiology:

    congenital  

     
     Pediatric Radiology CasesHistory:

    Mature newborn with retarded postnatal adaptation. On the first day of life, noticeable cyanotic skin color, oxygen saturation 70-80%. 1/6 systolic bruit.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    Congenital defect  

     
     Pediatric Radiology CasesRadiological findings:


    Pathology 1 <- view Pathology 1

    Pathology 1: Obvious generalized skin cyanosis.






    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Echocardiography: In the parasternal longitudinal axis, a so-called "Pistol double run" in the parallel lying aorta and the pulmonary trunk.

    Next to the shown (pathognomonic) sign of the pistol double run, there are typical sonographic-anatomical signs that show from which ventricle each of the vessels originate from.

    For a morphological right ventricle are the following criteria: The corresponding AV-valve is attached to the tip of the heart and is fixated with it's tendons to the septum. There is a coarse trabecularization (septomarginal trabecula), no fibrous continuity between the AV-valve and semilunar valve, but rather a muscular infudibulum.

    For the left ventricle: AV-valve - furthest away from the tip of the heart, no attachment to the septum, therefore 2 papillary muscles, smooth walls, fibrous continuity between the AV-valve and semilunar valve.

    All these morphological criteria can be well-seen in the parasternal longitudinal axis, the parasternal short axis and the 4 ventricle view.

     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    Total constellation (Consens)  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    N/A  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    Shortly after birth, the execution of a hyperoxic testes indicates differentiation of a pulmonary or a cardiac cause of the cyanosis in a persistent cyanotic child. A saturation to 100% makes the thought of a TGA impossible.

    TGA means that pulmonary and systemic circulation is in parallel, in the pulmonary circulation, the O2 saturated blood circulates through the lung; in the body, the blood is de-saturated. To increase the supply of O2 in the brain and organs, a shunt must be placed, which leads to the mixing of blood. It is therefore important to assess the shunt flow of the ductus arteriosus, the atria and in the case of VSD, at the level of the ventricles.

    If opening the ductus arteriosus with prostaglandine application, the pulmonary blood flow is increased. This means that the blood flow in the left atrium is increased, which leads to the inter-atrial connection. In increased flow through PgE application, one may observe an increase in the flow speed (in restrictive foramen ovale/ASD) in doppler sonography. This means that the gradient between the left and the right atrium is seen. This not only means that the blood which is mixed is reduced, but also that the pressure in the left atrium increases and can lead to congestion in the pulmonary circulation. Therefore, it is important to detect this by pw-doppler sonography after application of PgE. Clinically, cyanosis can continue to exist, signs of beginning pulmonary edema can be seen. The child does not improve. In fact, the child will worsen. It is recommended that the sonographic placement is substernal, so that the atrial septum is caught vertically, the resolution is the greatest that way, and therefore the doppler study can be used to assess the atrial shunt ideally.

    There must be a follow-up examination, because in bad situations, there is also an indication for a Rashkind Manoveur. After stabilization, a operative procedure should be considered (Switch surgery, Rastell surgery).  

     
     Pediatric Radiology CasesComments of the author about the case:

    N/A  

     
     Pediatric Radiology CasesFirst description / History:

    N/A  

     
     Pediatric Radiology CasesLiterature:

    1. Medline: Medline
    Waldman JD, Holmes G
    Transposition of the great arteries S.193-195
    in Skinner J, Alverson D, Hunter S
    Echocardiography for the neonatologist
    Churchill Livingstone, 1st Edition, 2000
     

     
     Pediatric Radiology CasesKeywords:

    cyanotic heart defect, TGA, transposition of the great arteries, transposition of the great vessels, systolic murmur, cyanosis, desaturation, child, childhood, pediatric radiology  

     
     Pediatric Radiology Cases Cite this article:

    H Eberhardt, S Kallsen. Transposition of great arteries (TGA). PedRad [serial online] vol 3, no. 6.
    URL: www.PedRad.info/?search=20030616161230  

     
     Pediatric Radiology Cases Read similar articles: with corresponding keywords
    in the same field: Thorax-Heart
    or in the region: Thorax
    or in the tissue/organ: Heart
    or with the etiology: congenital
     
     Pediatric Radiology CasesImages to this case: There are Ultrasound-images available for this case. [ Ultrasound ] There are Pathology-images available for this case. [ Pathology ] View all modalities [ All ]   
     
    Transposition of great arteries (TGA)
    H Eberhardt, S Kallsen. Transposition of great arteries (TGA). PedRad [serial online] vol 3, no. 6.
    URL: www.PedRad.info/?search=20030616161230


     

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    Transposition of great arteries (TGA)
    Other cases by these authors:

    Search H. Eberhardt in Medline H. Eberhardt (4)   
    Search S. Kallsen in Medline S. Kallsen (2)   

    Transposition of great arteries (TGA)  
     
    Transposition of great arteries (TGA)
    H Eberhardt, S Kallsen. Transposition of great arteries (TGA). PedRad [serial online] vol 3, no. 6.
    URL: www.PedRad.info/?search=20030616161230


     

    Which diagnosis have other collegues guessed?


    • Transposition of the great arteries
      Votes: 10 (90 %)


    • Persisting arterial duct
      Votes: 0 (0 %)


    • Left vena cava superior
      Votes: 1 (9 %)


    • Ring anomaly of the Aorta
      Votes: 0 (0 %)



        Total answers: 11

     
    Transposition of great arteries (TGA)
    H Eberhardt, S Kallsen. Transposition of great arteries (TGA). PedRad [serial online] vol 3, no. 6.
    URL: www.PedRad.info/?search=20030616161230


     

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    Transposition of great arteries (TGA)
    H Eberhardt, S Kallsen. Transposition of great arteries (TGA). PedRad [serial online] vol 3, no. 6.
    URL: www.PedRad.info/?search=20030616161230


     




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