Transposition of the Great Arteries with Multiple Interventricular Communications and Anomaly of the Coronary Arteries

Department of Cardiovascular CT and MRI of the Heart Hospital (HCor), São Paulo, Brazil|2018-01-23

Valéria de Melo Moreira, MD, Adriano Camargo de Castro Carneiro, MD, Tiago Augusto Magalhães, PhD, MD, Juliana Hiromi Silva Matsumoto Bello, MD, Carlos Eduardo Elias dos Prazeres, MD, Caroline Bastida de Paula, BM and Carlos Eduardo Rochitte, PhD, MD

A neonate was born with a diagnosis of transposition of the great arteries (TGA) and isolated sub-pulmonary ventricular septal defect (VSD). A postnatal echocardiogram confirmed the diagnosis and additionally revealed an anomaly of the coronary arteries. In view of the cardiac anatomy, spatial arrangement of the great vessels associated with the coronary anomaly, a surgical palliation with pulmonary artery (PA) banding and atrioseptostomy was performed on day 14 after birth. Seven months later, the patient returned for scheduled Senning surgery. Clinical examination revealed an ejection systolic cardiac murmur in the left upper sternal border and cyanosis with blood oxygen saturation of 75% at room air. Senning surgery was performed with ventriculoseptoplasty and removal of PA banding. In the postoperative period, the patient developed complications, including significant worsening of the respiratory condition and difficulties in extubation. Postoperative echocardiography showed a suspicious cava baffle stenosis. Cardiovascular CT was requested to evaluate intra-atrial baffle abnormalities.