J Cardiovasc Ultrasound.  2015 Mar;23(1):36-39. 10.4250/jcu.2015.23.1.36.

A Typical Case of L-Transposition of the Great Arteries Initially Presented as Complete Atrioventricular Block in Middle-Aged Man

• Park SH
• Choi JY
• Park EJ
• Kim HD
• Choi MJ
• Choi SI
• Kim JB
• Lee S
• Na JO

• KMID: 2135405
• DOI: http://doi.org/10.4250/jcu.2015.23.1.36

Abstract

L-transposition of the great arteries (L-TGA) is a rare congenital anomaly and could cause complete atrioventricular (AV) block at relatively younger age. We present a case of 43-year-old male who complained of dizziness due to complete AV block. We confirmed L-TGA using transthoracic echocardiography and cardiac computed tomography. Permanent pacemaker was inserted without complications. No invasive treatment including corrective surgery was performed because patient's cardiac function was almost normal and the symptom was completely resolved after pacemaker insertion.

Keyword

Congenital heart disease; L-transposition of the great arteries; Complete AV block

MeSH Terms

Adult
Arteries*
Atrioventricular Block*
Dizziness
Echocardiography
Heart Defects, Congenital
Humans
Male

Figure

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  Fig. 1 Electrocardiogram (A) and Holter (B) on admission. 2:1 atrioventricular (AV) block, Q wave in right precordial limb lead (V1, II, III), absent Q wave in left precordial lead (V5, V6) and left axis deviation (A), complete AV block (B) (arrow: P wave, arrowhead: QRS complex).

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  Fig. 2 Coronary angiography. There was no significant stenosis in left coronary arteries. Right coronary artery could not be examined due to failure of catheter engagement. LAD: left anterior descending artery, LCX: left circumflex artery.

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  Fig. 3 Chest X-ray after permanent pacemaker insertion. A lead was positioned at RA, and V lead was positioned at functional RV (morphologic LV). Right sided aortic arch was also identified. RA: right atrium, RV: right ventricle, LV: left ventricle.

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  Fig. 4 Transthoracic echocardiography. Parasternal long axis view (A), parasternal short axis view (B), apical four chamber view (C), right ventricular outflow view (D). mRV was located at systemic location and mLV at pulmonary circulation. Note PV and AV location was inverted at short axis view (B). Left-sided atrioventricular valve is inferiorly located closer to the cardiac apex than right-sided atrioventricular valve (C). AV: aortic valve, LA: left atrium, mLV: morphologic left ventricle, MPA: main pulmonary artery, mRV: morphologic right ventricle, PV: pulmonary valve, RA: right atrium, TV: tricuspid valve.

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  Fig. 5 Cardiac computed tomography, left-sided mRV has moderator band, coarse trabeculations (A). Aortic valve was abnormally located anterior, superior, and to the left of the pulmonic valve. Aorta arises anterior and leftward of pulmonary artery from the mRV (B and C). Right sided descending thoracic aorta with diverticulum of Kommerell (D). Ao: aorta, AV: aortic valve, Komm: diverticulum of Kommerell, LA: left atrium, mLV: morphologic left ventricle, mRV: morphologic right ventricle, PA: pulmonary artery, PV: pulmonary valve, RA: right atrium.

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