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Case of the Week # 236

Fabrice Cuillier, MD; H. M’Lamali, MD; X. Baron, MD; A. Berta

January 29, 2009 - February 5, 2009

Fabrice Cuillier, MD; H. M’Lamali, MD**; X. Baron, MD**; A. Berta***.

*    Department of Gynecology, Félix Guyon’Hospital, 97400 Saint-Denis, Ile de la Réunion, France;
**   Department of Gynecology, gabriel Martin’Hospital, 97420 Saint-Paul, Ile de la Réunion, France;
***  Student, Arizona State University. University Drive and Mill Avenue Tempe, Arizona 85281.

Case report

An 18-year-old woman (G1P0) was referred to our antenatal unit at 22 weeks because of a suspicion of a cardiac malformation. There was no known family history of congenital disease. The patient had neither a nuchal translucency nor a triple test done.

Our echocardiography revealed following findings:

Images 1, 2:

1A
1C

Images 3, 4, 5, 6:

4D
4E

2A
2B

Video 1, 2:

 

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Answer

Case report

An 18-year-old woman (G1P0) was referred to our antenatal unit at 22 weeks because of a suspicion of a cardiac malformation. There was no known family history of congenital disease. The patient did not have a nuchal translucency or triple test done.

Our echocardiography revealed following findings:

  • The four-chamber view of the heart showed inversed arrangement of the ventricles - morphological left ventricle was on the right side and was connected to the right atrium.
  • Morphological right ventricle was located on the left side and was connected to the left ventricle.
  • Foramen ovale flap was seen within the left atrium.
  • The pulmonary artery arose out of the right-sided (morphological left ventricle) and the aorta arose out of left-sided right ventricle.
  • The interventricular septum had a normal appearance.
  • The pulmonary artery and the aorta had a normal diameter.
  • The atrioventricular valves were not insufficient.

The findings were consistent with the diagnosis of congenitally corrected transposition of the great arteries. An amniocentesis was performed and revealed normal karyotype (46, XX).

The diagnosis of corrected transposition of the great arteries was confirmed after birth.

Images 1, 2: The images show four-chamber view of the heart with the right-sided left ventricle and left-sided right ventricle. Note the right-sided deviation and mesocardia.

1A
1C

Images 3, 4: The image 3 shows four-chamber view of the heart with the right-sided left ventricle and left-sided right ventricle. The image 4 shows a drawing explaining the mutual arrangement of structures of the heart (LA - left atrium, RA - right atrium, RV - right ventricle, LV - left ventricle).

1B
1B-drawing

Images 5, 6, 7, 8: The images show the outflow tracts - the pulmonary artery (AP) arises out of the right-sided left ventricle and the aorta (AO) arises out of the left-sided right ventricle.

4D
4E

2A
2B

Video 1, 2: The videos show the outflow tracts - the pulmonary artery arises out of the right-sided left ventricle and the aorta arises out of the left-sided right ventricle.

 

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