Diagram of the Embryological origins and Consequences of Conotruncal Malformations in an L Loop embryology bilateral conus DORV growth resorption normal mitral to aortic continuity transposition D transposition double outlet right ventricle Ashley Davidoff 06394c02L01s TheCommonVein.net Common Conotruncal Abnormalities The image reflects the relationship of the aorta and pulmonary arteries in the normal patient, in DTGA, LTGA and DORV. In the normal patient with D loop the aorta (Ao) is posterior and to the right, and the pulmonary artery (PA) is anterior and to the right. In the patient with DTGA, the Ao is anterior and to the right and the PA is posterior and to the left. In an L loop the Ao is anterior and to the left and the PA is posterior and to the right. In double outlet right ventricle (DORV) the great vessels lie side by side and in DORV with a D loop the aorta is to the right and with an L loop the aorta is to the left 86778 01639 01639d02 01639d04 01639f03.jpg Anterior aorta = Transposition Ashley Davidoff MD TheCommonVein.net Corrected Transposition of the Great Arteries. An anteroposterior chest radiograph reveals the straightened left heart border formed by the aorta, which is more leftward and anterior than usual. eMediciene L TGA Aorta is Anterior and Leftward and Pulmonary Artery is Posterior The axial CT reveals a findings characteristic of L transposition of the aorta with an anteriorly and leftward positioned aorta and posteriorly and rightward positioned pulmonary artery best seen in images c and d. In images a and b the distinction between aorta and pulmonary cannot be determined unless identifying which of the 2 vessels connects with the aortic arch 28999b01 heart cardiac aorta pulmonary artery RVOT conotruncal malformation LTGA L TGV transposition of the great vessels transposition of the great arteries corrected transposition position connection relation embryology CTscan Davidoff MD 28994 28995 28996 28997 28998 28999 MRI Ashley Davidoff MD TheCommonVein.net LTGA The left sided right ventrcle, receives oxygenated blood from the left sided left atrium, and gives rise to the left sided aorta. This configuration results in a soft tissue shape abnormality in the region of the AP window TheCommonVein.net L TGA Aorta is Anterior and Leftward and Pulmonary Artery is Posterior The axial CT reveals a findings characteristic of L transposition of the aorta with an anteriorly and leftward positioned aorta and posteriorly and rightward positioned pulmonary artery. 07304b01 anterior aorta posterior pulmonary artery position connection subaortic conus L TGA L TGV L transposition of the great vessels L transposition of the great arteries levo leftward MRI Ashley Davidoff MD TheCommonVein.net
Fig. 4A ?ECG-gated axial spin-echo T1-weighted MR images in patient with dextrocardia, situs solitus, and corrected transposition of great arteries (TGA). (Reprinted with permission from Reddy GP, Caputo GR. Diagnosis please: case 15. Radiology 1999; 211:709-710 [2]) Liver is on right and spleen is on left (bottom image), revealing situs solitus. Image through cardiac chambers (top image) shows discordant atrioventricular connections. Inferior pulmonary veins (arrowheads) drain to morphologic left atrium (LA). Left atrium is connected to morphologic right ventricle (RV), which is distinguished by presence of a moderator band (arrow). Morphologic right atrium (RA) is connected to morphologic left ventricle (LV). Ventricles are in L-loop configuration. Read More: https://www.ajronline.org/doi/10.2214/AJR.06.1179 https://www.ajronline.org/doi/10.2214/AJR.06.1179 Fig. 4B ?ECG-gated axial spin-echo T1-weighted MR images in patient with dextrocardia, situs solitus, and corrected transposition of great arteries (TGA). (Reprinted with permission from Reddy GP, Caputo GR. Diagnosis please: case 15. Radiology 1999; 211:709-710 [2]) Images at progressively higher levels show muscular outflow tract or infundibulum (I, top image), which is characteristic of a morphologic right ventricle. Pulmonary artery (P) arises from outflow tract of morphologic left ventricle (LV, top image). Right-sided atrioventricular valve (arrowhead, top image) is near root of pulmonary artery because of fibrous continuity of inflow and outflow valves characteristic of a morphologic left ventricle. In lower image, aortic root (A) arises from morphologic right ventricle. Discordant atrioventricular and ventriculoarterial connections define disorder as congenitally corrected TGA. This case represents L-TGA because aorta is to left of pulmonary artery. RA = right atrium, S = superior vena cava. Read More: https://www.ajronline.org/doi/10.2214/AJR.06.1179
Fig. 5C ?Images from ECG-gated CT scan of 52-year-old woman with dextrocardia, situs inversus, and congenitally corrected transposition of great arteries (TGA). Reformatted oblique coronal image through outflow tract of posterior ventricle shows muscular infundibulum (arrows) separating inflow and outflow regions and confirming that posterior ventricle is a morphologic right ventricle (RV). Ventricle connects to aorta (A). LA = morphologic left atrium. Read More: https://www.ajronline.org/doi/10.2214/AJR.06.1179 Fig. 5D ?Images from ECG-gated CT scan of 52-year-old woman with dextrocardia, situs inversus, and congenitally corrected transposition of great arteries (TGA). Volume-rendered image from anterior view provides 3D perspective of relationships of cardiac chambers and great vessels. Aortic valve is superior and to right of pulmonic valve, as expected with D-TGA. Pulmonary artery (P) is enlarged in this patient due to pulmonary arterial hypertension that is likely secondary to tricuspid valve disorder. Even though patient has situs inversus, anterior descending coronary artery (arrowheads) is supplied by left coronary artery (arrow) because ventricles are in D-loop configuration. LA = morphologic left atrium, LV = morphologic left ventricle, RA = morphologic right atrium, RV = morphologic right ventricle, SVC = superior vena cava. Read More: https://www.ajronline.org/doi/10.2214/AJR.06.1179 Fig. 5A ?Images from ECG-gated CT scan of 52-year-old woman with dextrocardia, situs inversus, and congenitally corrected transposition of great arteries (TGA). Axial image through upper abdomen shows liver on left and spleen and stomach (St) on right, consistent with situs inversus. Read More: https://www.ajronline.org/doi/10.2214/AJR.06.1179
L – Loop DORV
06394c02Ls embryology bilateral conus DORV growth resorbtion normal mitral to aortic continuity transposition L transposition corrected transposition double outlet right ventricle Davidoff art copyright 2009 all rights reserved
