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An adult patient with congenitally corrected transposition of the great arteries.

A26-year-old patient developed a symptomatic pericardial effusion 3 weeks after placement of an automatic implantable cardioversion device and a biventricular pacemaker with an epicardial ventricular lead. His medical history included congenitally corrected transposition of the great arteries (CC-TGA) and chronic congestive heart failure. Consent for this presentation was obtained from the patient. The patient underwent creation of a pericardial window. Because the pericardial fluid appeared sanguineous, transesophageal echocardiography was requested for surgical guidance and surveillance for fluid reaccumulation. The midesophageal (ME) 4-chamber view established situs solitus, because the left atrium, identified by its appendage and pulmonary veins, was to the left of the interatrial septum (Video 1, loop 1; see Supplemental Digital Content 1, http://links.lww.com/AA/A182; see Appendix for video legend). The atrioventricular valve to the left of the interventricular septum was identified as the tricuspid valve (TV) by its apical position and chordal attachment to the septum (Video 1, loop 2, http://links.lww.com/AA/A182), thereby identifying the heavily trabeculated ventricle to the left of the interventricular septum as the morphologic right ventricle (RV). The atrioventricular valve to the right of the interventricular septum was identified as the mitral valve (MV) by its basal position, establishing the ventricle to the right of the interventricular septum as the morphologic left ventricle (LV). The LV morphology was confirmed by its elongated cavity, smooth endocardial surface, and presence of distinct papillary muscles. Maintaining the dextropositioned ventricle in the center of the sector, forward rotation to 51° (modified ME inflowoutflow view) allowed visualization of a fibrous continuity between its inflow and outflow valves (MV and pulmonic), indicative of LV morphology (Video 1, loop 3, http://links.lww.com/AA/A182). Further rotation to the ME long-axis (LAX) view imaged the ventricle to the left of the interventricular septum and identified extensive coarse apical trabeculations and fibrous discontinuity between the TV and aortic valve caused by the presence of the RV infundibulum (conus), characteristic of RV morphology. The aorta was visualized anterior and parallel to the pulmonary artery (PA) (Video 1, loop 4, http://links.lww.com/AA/A182); the main PA was further identified by its branching into the right and left arteries. Rightward rotation of the transducer to the bicaval view confirmed the situs solitus because the right atrium, identified by its appendage, great veins, and the coronary sinus, was to the right of the interatrial septum (Video 1, loop 5, http://links.lww.com/AA/A182). The transgastric short-axis view confirmed the trileaflet structure of the TV (Video 1, loop 6, http://links.lww.com/AA/A182) and allowed the functional assessment of the systemic (morphologic right) ventricle (Video 1, loop 7, http://links.lww.com/AA/A182). The patient tolerated the procedure well and was returned to the ward in satisfactory condition.