Abstract
Transposition of the great arteries (TGA) is a form of conotruncal abnormalities in which the aorta arises from the morphological right ventricle (RV) and pulmonary artery arises from the morphological left ventricle (ventriculoarterial discordance). TGA encompasses two distinct defects, complete TGA and congenitally corrected TGA. Complete TGA is the ninth most common congenital heart defect and the second most common cyanotic lesion after tetralogy of Fallot. Congenitally corrected TGA is rarer and accounts for less than 1% of congenital heart defects.
The role of cardiac magnetic resonance imaging (CMR) in these defects is dictated by the specific cardiac anatomy and by the reparative surgical interventions present (if any). In cases of congenitally corrected TGA, CMR can be instrumental in discriminating between the morphologic right and left ventricles, in characterizing abnormalities of viscero-atrial situs, and in describing the associated cardiac anomalies that are nearly universally present. In the patients with complete TGA, almost all of whom will have had corrective surgery early in life; CMR can assess patency of conduits and baffles and presence of residual defects. Furthermore, when the morphologic RV is in the systemic position, it is prone to failure over time. Echocardiography for right ventricular function assessment is less accurate in this setting, and ventricular function and reserve may be better assessed by CMR.
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13.1 Electronic Supplementary Materials
Movie 13.1
Axial SSFP cine of a patient with complete TGA following an atrial baffle procedure through the superior systemic baffle draining into the left ventricle (AVI 82557 kb)
Movie 13.2
SSFP cine in the four chamber orientation through a portion of the pulmonary baffle in a patient with complete TGA and a prior atrial baffle procedure. The right ventricle and tricuspid valve annulus are significantly dilated with resultant tricuspid regurgitation (AVI 82557 kb)
Movie 13.3
Right ventricular outflow tract SSFP cines demonstrating the relationship of the left ventricular outflow tract and the pulmonary conduit in a patient with a prior Rastelli procedure for complete TGA. Poor coaptation of pulmonic valve and pulmonic insufficiency can be seen (AVI 57790 kb)
Movie 13.4
Three chamber or left ventricular outflow view SSFP cines in a patient with a Rastelli procedure for complete TGA with an associated VSD. Narrowing in the LVOT is seen with turbulent flow below the aortic valve. The narrowing in the LVOT did not produce a significant gradient by echocardiography (1.8Â m/s) (AVI 60542 kb)
Movie 13.5
Coronal SSFP cine through the outflow tracts of an adult with previously unrecognized congenitally corrected TGA and situs inversus totalis. The systemic right ventricle is massively dilated and failing. The side-by-side orientation of the outflow tracts common in congenitally corrected TGA is well demonstrated here. Both semilunar valves demonstrate insufficiency which was subsequently further characterized by oblique axial phase contrast images through the outflow tracts. While dextrocardia or mesocardia is present in up to 20% of patients with congenitally corrected TGA, situs inversus totalis is very rare. The left-sided liver and right-sided gastric bubble can be seen in this image (AVI 68798 kb)
Movie 13.6
Four chamber orientation of an SSFP-based resting perfusion sequence in a patient with congenitally corrected TGA, situs inversus totalis and a failing systemic right ventricle. Perfusion was obtained to further evaluate possible intracardiac thrombus noted on SSFP cines. The oblong structures along the septum of the systemic right ventricle do not perfuse, nor did they enhance on delayed images, supporting the diagnosis of intracardiac thrombus. Thrombus had not been identified on prior echocardiography evaluation (AVI 137593 kb)
Movie 13.7
Coronal SSFP cine of an adult patient with congenitally corrected TGA and a large outflow VSD. Turbulent flow is seen through the subpulmonic outflow, which is narrowed, and across the VSD in a left-to-right shunt into a dilated main pulmonary artery. The Qp/Qs by subsequent heart catheterization confirmed to be 2.1:1 (AVI 82557 kb)
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Wilson, J.R., Syed, M.A. (2023). Transposition of Great Arteries. In: Syed, M.A., Mohiaddin, R.H. (eds) Magnetic Resonance Imaging of Congenital Heart Disease. Springer, Cham. https://doi.org/10.1007/978-3-031-29235-4_13
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DOI: https://doi.org/10.1007/978-3-031-29235-4_13
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