Multimodality Imaging of Transposition of the Great Arteries
A practical radiology review of Multimodality Imaging of Transposition of the Great Arteries, focused on imaging findings, differential diagnosis, reporting points, and...
A practical radiology review of Multimodality Imaging of Transposition of the Great Arteries, focused on imaging findings, differential diagnosis, reporting points, and high-yield teaching pearls.
Overview
- Congenital conotruncal abnormality
- Aorta ↔ RV, PA ↔ LV → ventriculoarterial discordance
2 types
- D-TGA (complete) → Atrioventricular concordance+Ventriculoarterial discordance
- CCTGA (congenitally corrected) → Atrioventricular discordance+Ventriculoarterial discordance
Epidemiology & Presentation
- D-TGA = most common neonatal cyanotic CHD
- 5–7% of CHD, >
- Cyanosis ↗ if poor mixing (ASD/VSD/PDA help survival)
Imaging Modalities
- Echo – first-line (morphology, function, hemodynamics)
- MRI – best for postsurgical follow-up (RV, baffles, function)
- CT – for coronary anatomy, conduits, MRI contraindication
- Cath – for interventions (stents, balloon septostomy)
D-TGA Surgical Option s
- AtrSO (Mustard/Senning) → atrial baffles redirect flow
- ASO (Jatene) → arterial switch + LeCompte maneuver (PA anterior to Ao)
- Rastelli/Nikaidoh → for VSD + LVOTO
Complications by Surgery Type
AtrSO
- Arrhythmia (SA node injury) Baffle stenosis/leak Systemic (RV) failure Tricuspid regurgitation RV fibrosis
- ASO Coronary kinking/stenosis (2–11%) Neoaortic root dilation & regurgitation PA/branch stenosis (5–40%) Aortopulmonary collaterals
- Rastelli/Nikaidoh RV–PA conduit stenosis/calcification Baffle leak or aneurysm Arrhythmia / sudden cardiac death CCTGA Highlights
- Double discordance physiologically corrected
- Often asymptomatic till adulthood
- Associated with VSD (80%), PS/LVOTO (50%), TR/Ebstein (30%)
- Systemic RV → eventual failure + TR
Surgical options
- Conventional repair → systemic RV preserved • Double switch (AtrSO + ASO) or Senning–Rastelli = anatomic correction
MRI Pearls
- ASO hallmark: PA anterior to ascending aorta
- AtrSO: visualize systemic & pulmonary baffles
- Baffle leak: Qp/Qs > 1.2 or < 0.8 significant
- RV fibrosis: late gad enhancement patterns
- CCTGA: LV continuity (fibrous) vs RV (muscular infundibulum)
Key Takeaways
- Know segmental anatomy The Van Praagh classification ({S,D,D} vs [{S,L,L} -->situssolitus with l-looped ventricles and l-transposed arteries])
- Echo → diagnosis; MRI → follow-up; CT → coronaries
- Recognize post-surgical landmarks (baffles, conduits, neoaorta)
- Always assess for stenosis, leak, RV function, TR, and coronary patency
Clinical use note
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