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Transposition of the great arteries


Transposition of the great arteries is a congenital cardiac anomaly defined by origin of the aorta from the right ventricle and origin of the pulmonary trunk from the left ventricle. The ventricular septum may be intact (simple transposition of the great arteries), or there may be a defect in the ventricular septum (transposition with ventricular septal defect).

Morphology

Figure 22-1, A Transposition of the great arteries, external view. The aorta originates from the right ventricle (ventriculoarterial discordant connection). It is anterior and to the right of the pulmonary artery, which arises from the left ventricle. B Transposition of the great arteries, right ventricular view. The heavily trabeculated anatomic right ventricle is enlarged and hypertrophied. The right ventricular outflow tract, with its well-defined crista supraventricularis and ventricular infundibular fold, is in continuity with the aorta. The ostia of the coronary arteries confirm that this is the aorta. The aortic valve is normal. C Transposition of the great arteries, left ventricular view. The finely trabeculated left ventricle is in continuity with the pulmonary trunk. The pulmonary valve is continuous with the mitral valve. The left ventricle has a thin wall because it pumps blood to the low-pressure pulmonary circulation. D Transposition of the great arteries with ventricular septal defect. The aorta originates anteriorly from the right ventricle. The pulmonary trunk arises from the left ventricle and is located posterior to and to the left of the aorta. There is a ventricular septal defect in the membranous portion of the septum. The left ventricle is hypertrophied. E Transposition of the great arteries with ventricular septal defect, magnified view. This view shows details of the close relationship between the ventricular septal defect and the pulmonary valve. The pulmonary valve is normal.

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