Corrected transposition of great vessels: symptoms, diagnosis, treatment

Corrected transposition of the main vessels is referred to as rare congenital heart anomalies. However, clinical deviations in the corrected transposition of the main vessels are minimal and, most likely, the defect often remains undiagnosed. Corrected transposition of the main vessels is characterized by the following changes. The morphologically formed right ventricle with the tricuspid valve is located to the left, circulating arterial blood in it and leaving the aorta that occupies the left-sided position; a morphologically formed left ventricle with a two-leaf valve is located on the right. It receives venous blood, which is sent to the pulmonary artery, located to the right of the aorta. Corrected transposition of the main vessels is characterized by an abnormal arrangement of the conduction system of the heart. The AV node is located at the lower part of the interatrial septum above and to the left of the central fibrous body, the bundle of the Geis is elongated, since it passes from the right to the left atrium, then into the posterior section of the interventricular septum. Hemodynamics with this anomaly without other associated congenital heart defects has no special features, except for the arterial (tricuspid) valve that arises with age, which is not adapted to functioning under high pressure conditions. Of great importance is the functional state of the myocardium of the right (left) ventricle, as it pumps blood into the large circulation. With its dilatation, relative "mitral" insufficiency may occur.

In the absence of other concomitant congenital heart defects, complaints are absent in children. Against the background of an abnormal arrangement of the conducting system, paroxysmal tachycardia, AV blockade of a high degree may occur, which is often attributed to a possible myocarditis. To suspect corrected transposition of the main vessels, electrocardiographic examination data allow: the deviation of the electric axis of the heart to the left from 0 to -20 °, sometimes the Wolff-Parkinson-White phenomenon, signs of arterial ventricular overload, the absence of a Q wave in the left thoracic leads and its presence in II, III , aVF and right pectorals. It should be remembered, however, that there are no specific ECG signs of a corrected transposition of the main vessels.

This defect is often an accidental finding in echocardiographic examination. The main signs of a defect:

• changes in the echogram of the tricuspid valve located behind the interventricular septum, evidence of ventricular inversion;
• echogram located on the front and left of the aorta and absence of contact between the arterial AV valve and the main vessels, which indicates the inverted arrangement of the vessels.

Cardiac catheterization and angiocardiography do not have any advantages over Echocardiography, and studies are being conducted to clarify the nature of pulmonary hypertension.

Treatment of corrected transposition of the main vessels

In an option uncomplicated by other congenital heart defects, with age, it may be necessary to replace the arterial valve in case of severe deficiency.

[1], [2], [3], [4], [5], [6], [7], [8]