Congenitally corrected transposition of great arteries detected by coronary computed tomography-angiography

    Authors

    Keywords

    congenitally corrected transposition of great arteries, congenital structural heart disease, coronary computed tomography angiography

    DOI

    https://doi.org/10.15836/ccar2022.234

    Full Text

    **Introduction**: Congenitally corrected transposition of great arteries (CCTGA) is a rare structural heart disease constituting less than 1% of all congenital heart diseases. It is characterized by a unique anatomy of morphologically swapped ventricles and malposition of aortic root and pulmonary trunk (1-3). Despite the transposition, physiological blood pools are preserved. Patients may not be diagnosed until adulthood, when left-located right ventricle begins to fail due to dealing with systemic blood flow. They may also present with heart rhythm or conduction disorders. The aim is to present a case of CCTGA detected by coronary computed tomography angiography (CCTA). **Case report**: 58-year-old woman with suspected coronary artery disease (CAD) was referred to our clinic for a CCTA. Presenting symptoms were occasional unprovoked tachycardia accompanied by atypical chest discomfort and decreased ability to endure physical exertion. Patient mentioned (without in-hand report) that recent echocardiogram was unremarkable. Physical examination and blood tests were done. Among risk factors, arterial hypertension and dyslipidemia were recorded. CCTA was performed and revealed anomalous coronary arteries originating from anteriorly placed aorta where pulmonary trunk was behind aorta and both great arteries running parallel to each other that was consistent with CCTGA. No CAD was found. **Conclusion**: CTA is nowadays recommended as the initial test for diagnosing or excluding CAD after clinical assessment. It is also used as a complementary modality to echocardiography in evaluation of congenital heart diseases. In our case, CCTA revealed CCTGA. It is a complex condition that can be overlooked or underestimated due to its initial clinical insignificance. Even though the condition was probably assessed in earlier life, CCTGA should have been followed up regularly because of chance of reduction of cardiac function or disorder of cardiac rhythm.

    Literature

    1. Agarwal A, Samad F, Kalvin L, Bush M, Tajik AJ. A great imitator in adult cardiology practice: congenitally corrected transposition of the great arteries. Congenit Heart Dis. 2017 March;12(2):143–52. https://doi.org/10.1111/chd.12453
    2. Kumar TKS. Congenitally corrected transposition of the great arteries. J Thorac Dis. 2020 March;12(3):1213–8. https://doi.org/10.21037/jtd.2019.10.15
    3. Placci A, Lovato L, Bonvicini M. Congenitally corrected transposition of the great arteries in an 83-year-old asymptomatic patient: description and literature review. BMJ Case Rep. 2014 October 21;2014:bcr2014204228. https://doi.org/10.1136/bcr-2014-204228
    Cardiologia Croatica
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    Congenitally corrected transposition of great arteries detected by coronary computed tomography-angiography

    Extended Abstract
    Issue9-10
    Published
    Pages234
    PDF via DOIhttps://doi.org/10.15836/ccar2022.234
    congenitally corrected transposition of great arteries
    congenital structural heart disease
    coronary computed tomography angiography

    Authors

    Antun Zvonimir Kovač*ORCID“Agram” Special Hospital, Zagreb, Croatia
    Lidija PlešORCID“Agram” Special Hospital, Zagreb, Croatia
    Kata ĆorićORCID“Agram” Special Hospital, Zagreb, Croatia
    Petar MedakovićORCID“Agram” Special Hospital, Zagreb, Croatia
    Ladislav PavićORCID“Agram” Special Hospital, Zagreb, Croatia
    Mladen JukićORCID“Agram” Special Hospital, Zagreb, Croatia

    *Correspondence email: azkovac@gmail.com

    Full Text

    Introduction: Congenitally corrected transposition of great arteries (CCTGA) is a rare structural heart disease constituting less than 1% of all congenital heart diseases. It is characterized by a unique anatomy of morphologically swapped ventricles and malposition of aortic root and pulmonary trunk (1–3). Despite the transposition, physiological blood pools are preserved. Patients may not be diagnosed until adulthood, when left-located right ventricle begins to fail due to dealing with systemic blood flow. They may also present with heart rhythm or conduction disorders. The aim is to present a case of CCTGA detected by coronary computed tomography angiography (CCTA).

    Case report: 58-year-old woman with suspected coronary artery disease (CAD) was referred to our clinic for a CCTA. Presenting symptoms were occasional unprovoked tachycardia accompanied by atypical chest discomfort and decreased ability to endure physical exertion. Patient mentioned (without in-hand report) that recent echocardiogram was unremarkable. Physical examination and blood tests were done. Among risk factors, arterial hypertension and dyslipidemia were recorded. CCTA was performed and revealed anomalous coronary arteries originating from anteriorly placed aorta where pulmonary trunk was behind aorta and both great arteries running parallel to each other that was consistent with CCTGA. No CAD was found.

    Conclusion: CTA is nowadays recommended as the initial test for diagnosing or excluding CAD after clinical assessment. It is also used as a complementary modality to echocardiography in evaluation of congenital heart diseases. In our case, CCTA revealed CCTGA. It is a complex condition that can be overlooked or underestimated due to its initial clinical insignificance. Even though the condition was probably assessed in earlier life, CCTGA should have been followed up regularly because of chance of reduction of cardiac function or disorder of cardiac rhythm.

    Literature

    1. 1.
      Agarwal A, Samad F, Kalvin L, Bush M, Tajik AJ. A great imitator in adult cardiology practice: congenitally corrected transposition of the great arteries. Congenit Heart Dis. 2017 March;12(2):143–52.DOI
    2. 2.
      Kumar TKS. Congenitally corrected transposition of the great arteries. J Thorac Dis. 2020 March;12(3):1213–8.DOI
    3. 3.
      Placci A, Lovato L, Bonvicini M. Congenitally corrected transposition of the great arteries in an 83-year-old asymptomatic patient: description and literature review. BMJ Case Rep. 2014 October 21;2014:bcr2014204228.DOI