pediatrics
Congenitally Corrected Transposition of the Great Arteries
Diagnosis of CCTGA
Physical examination Chest x-ray and ECG Echocardiography MRI and CT Cardiac catheterization Clinical findings will depend on the associated lesions, but a universal finding is the presence of a loud single second heart sound (S2) heard at the base of the heart due to the leftward and anterior location of the aorta. The aortic closure sound often generates a localized palpable impulse at the upper right or left parasternal area. The ECG may show AV block or abnormal Q waves in the right precordial leads (due to reversal of septal depolarization). There is an increased incidence of Atrial Fibrillation and Wolff-Parkinson-White Syndrome (WPW) with this anomaly. The chest x-ray usually shows a straight upper left heart border (because of the abnormal position of the ascending aorta) in addition to a more midline or right-sided position of the heart. The diagnosis should be obvious on the echocardiogram, which demonstrates the morphology of the ventricles to be reversed with the right-sided ventricle (morphologic LV) giving rise to a posterior pulmonary root and left-sided ventricle (morphologic RV) giving rise to an anterior and leftward aortic root. Associated defects are also well defined by this imaging modality. MRI and CT scans are often used to provide additional anatomic detail and provide the most reliable evaluation of right and left ventricular function. Cardiac catheterization is sometimes required to accurately evaluate intracardiac pressures, including pulmonary artery pressure and resistance. 