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D-Transposition of Great Arteries
Brett W. Carter, MD; Prabhakar Rajiah, MBBS, MD, FRCR, FSCMR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Dextro transposition of great arteries (D-TGA)
            • D = dextro = right
          • Definitions

            • Atrioventricular (AV) concordance and ventriculoarterial discordance
              • Aorta arises from right ventricle (RV); pulmonary trunk arises from left ventricle (LV)
            • Anatomic arrangement represented by designation "S, D, D" (Van Praagh segmental approach)
              • S: Visceroatrial situs solitus
                • Right atrium, liver on right
                • Left atrium, stomach, spleen on left
                • Right-sided trilobed lung with eparterial bronchus
                • Left-sided bilobed lung with hypoarterial bronchus
              • D: D-looped ventricles
                • Morphologic RV on right
                • Morphologic LV on left
              • D: D-transposed great arteries
                • Ascending aorta located anterior and to right of pulmonary artery (PA)
                • Great vessels parallel instead of crossing
            • Category: Cyanotic, cardiomegaly, increased pulmonary vascularity
            • Hemodynamics
              • RV → systemic circulation: Pressure overload
              • LV → pulmonary circulation: Volume overload
              • 2 parallel circuits
                • Incompatible with life without flow admixture
                  • PDA; VSD; PFO

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Echocardiographic Findings

                    • Angiographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        Selected References

                                        1. Ranganath P et al: Computed tomography in adult congenital heart disease. Radiol Clin North Am. 57(1):85-111, 2019
                                        2. Swanson SK et al: Interpretation and reporting of coronary arteries in transposition of the great arteries: Cross-sectional imaging perspective. J Thorac Imaging. 33(4):W14-W21, 2018
                                        3. Etesami M et al: Utility of late gadolinium enhancement in pediatric cardiac MRI. Pediatr Radiol. 46(8):1096-113, 2016
                                        4. Frank L et al: Cardiovascular MR imaging of conotruncal anomalies. Radiographics. 30(4):1069-94, 2010
                                        5. Lapierre C et al: Segmental approach to imaging of congenital heart disease. Radiographics. 30(2):397-411, 2010
                                        6. Ferguson EC et al: Classic imaging signs of congenital cardiovascular abnormalities. Radiographics. 27(5):1323-34, 2007
                                        7. Laffon E et al: Quantitative MRI comparison of pulmonary hemodynamics in mustard/senning-repaired patients suffering from transposition of the great arteries and healthy volunteers at rest. Eur Radiol. 16(7):1442-8, 2006
                                        8. Mohrs OK et al: Time-resolved contrast-enhanced MR angiography of the thorax in adults with congenital heart disease. AJR Am J Roentgenol. 187(4):1107-14, 2006
                                        9. Warnes CA: Transposition of the great arteries. Circulation. 114(24):2699-709, 2006
                                        10. Babu-Narayan SV et al: Late gadolinium enhancement cardiovascular magnetic resonance of the systemic right ventricle in adults with previous atrial redirection surgery for transposition of the great arteries. Circulation. 111(16):2091-8, 2005
                                        11. Raman SV et al: Usefulness of multidetector row computed tomography to quantify right ventricular size and function in adults with either tetralogy of Fallot or transposition of the great arteries. Am J Cardiol. 95(5):683-6, 2005
                                        12. Taylor AM et al: MR coronary angiography and late-enhancement myocardial MR in children who underwent arterial switch surgery for transposition of great arteries. Radiology. 234(2):542-7, 2005
                                        13. Tops LF et al: Intraatrial repair of transposition of the great arteries: use of MR imaging after exercise to evaluate regional systemic right ventricular function. Radiology. 237(3):861-7, 2005
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Clinical Issues

                                                TERMINOLOGY

                                                • Abbreviations

                                                  • Dextro transposition of great arteries (D-TGA)
                                                  • D = dextro = right
                                                • Definitions

                                                  • Atrioventricular (AV) concordance and ventriculoarterial discordance
                                                    • Aorta arises from right ventricle (RV); pulmonary trunk arises from left ventricle (LV)
                                                  • Anatomic arrangement represented by designation "S, D, D" (Van Praagh segmental approach)
                                                    • S: Visceroatrial situs solitus
                                                      • Right atrium, liver on right
                                                      • Left atrium, stomach, spleen on left
                                                      • Right-sided trilobed lung with eparterial bronchus
                                                      • Left-sided bilobed lung with hypoarterial bronchus
                                                    • D: D-looped ventricles
                                                      • Morphologic RV on right
                                                      • Morphologic LV on left
                                                    • D: D-transposed great arteries
                                                      • Ascending aorta located anterior and to right of pulmonary artery (PA)
                                                      • Great vessels parallel instead of crossing
                                                  • Category: Cyanotic, cardiomegaly, increased pulmonary vascularity
                                                  • Hemodynamics
                                                    • RV → systemic circulation: Pressure overload
                                                    • LV → pulmonary circulation: Volume overload
                                                    • 2 parallel circuits
                                                      • Incompatible with life without flow admixture
                                                        • PDA; VSD; PFO

                                                IMAGING

                                                • General Features

                                                  • Radiographic Findings

                                                    • CT Findings

                                                      • MR Findings

                                                        • Echocardiographic Findings

                                                          • Angiographic Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Staging, Grading, & Classification

                                                                    • Gross Pathologic & Surgical Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              Selected References

                                                                              1. Ranganath P et al: Computed tomography in adult congenital heart disease. Radiol Clin North Am. 57(1):85-111, 2019
                                                                              2. Swanson SK et al: Interpretation and reporting of coronary arteries in transposition of the great arteries: Cross-sectional imaging perspective. J Thorac Imaging. 33(4):W14-W21, 2018
                                                                              3. Etesami M et al: Utility of late gadolinium enhancement in pediatric cardiac MRI. Pediatr Radiol. 46(8):1096-113, 2016
                                                                              4. Frank L et al: Cardiovascular MR imaging of conotruncal anomalies. Radiographics. 30(4):1069-94, 2010
                                                                              5. Lapierre C et al: Segmental approach to imaging of congenital heart disease. Radiographics. 30(2):397-411, 2010
                                                                              6. Ferguson EC et al: Classic imaging signs of congenital cardiovascular abnormalities. Radiographics. 27(5):1323-34, 2007
                                                                              7. Laffon E et al: Quantitative MRI comparison of pulmonary hemodynamics in mustard/senning-repaired patients suffering from transposition of the great arteries and healthy volunteers at rest. Eur Radiol. 16(7):1442-8, 2006
                                                                              8. Mohrs OK et al: Time-resolved contrast-enhanced MR angiography of the thorax in adults with congenital heart disease. AJR Am J Roentgenol. 187(4):1107-14, 2006
                                                                              9. Warnes CA: Transposition of the great arteries. Circulation. 114(24):2699-709, 2006
                                                                              10. Babu-Narayan SV et al: Late gadolinium enhancement cardiovascular magnetic resonance of the systemic right ventricle in adults with previous atrial redirection surgery for transposition of the great arteries. Circulation. 111(16):2091-8, 2005
                                                                              11. Raman SV et al: Usefulness of multidetector row computed tomography to quantify right ventricular size and function in adults with either tetralogy of Fallot or transposition of the great arteries. Am J Cardiol. 95(5):683-6, 2005
                                                                              12. Taylor AM et al: MR coronary angiography and late-enhancement myocardial MR in children who underwent arterial switch surgery for transposition of great arteries. Radiology. 234(2):542-7, 2005
                                                                              13. Tops LF et al: Intraatrial repair of transposition of the great arteries: use of MR imaging after exercise to evaluate regional systemic right ventricular function. Radiology. 237(3):861-7, 2005