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Archives of cardiovascular diseases
Volume 104, n° 1
pages 61-63 (janvier 2011)
Doi : 10.1016/j.acvd.2010.02.001
Received : 21 January 2010 ;  accepted : 4 February 2010
Segmental analysis of a complex congenital heart disease using cardiac MDCT. Analyse of congenital heart disease: use of MDCT
Intérêt du scanner dans l’analyse segmentaire des cardiopathies congénitales complexes. Analyse segmenatire des cardiopathies congénitales par le scanner
 

Elise Barre , Jean-Francois Paul
Centre chirurgical Marie-Lanelongue, 133, avenue de la Résistance, 92350 Le Plessis Robinson, France 

Corresponding author. 41, rue Violet, 75015 Paris, France. Fax: +33 1 56 09 26 64.

Keywords : Congenital heart disease, Imaging, CT scan


We report a 67-year-old woman who was diagnosed at adulthood a rare and complex congenital heart disease: a corrected transposition of the great vessels and situs inversus.

Patient presented with progressive worsening right heart failure (NYHA class 2).

A cardiac MDCT scan was scheduled to plan surgical tricuspid replacement.

According to the segmental analysis using axial slices, MDCT showed situs inversus and atrio-ventricular discordance (Figure 1), associated with ventriculo-arterial discordance (Figure 2). In addition, unique coronary artery was disclosed using 3D images (Figure 3).



Figure 1


Figure 1. 

Axial slices from upper abomen to the thorax level. a: on the abdominal level: the liver is on the left side, corresponding to an abdominal situs inversus; b: on the thoracic level: the inferior venae cavae is connected to the right atrium, the latter being left-sided: atrial situs inversus; c: the right ventricle (with trabeculations) is on the right side of the thorax and the left ventricle on the left one (normal ventricular situs); d: the right atrium is connected to the left ventricle and the left atrium is connected to the right ventricle (atrioventricular discordance). Ao: Aorta; CA: coronary artery; IVC: inferior venae cavae; LA: left atrium; LV: left ventricle; PA: pulmonary artery; RA: right atrium; RV: right ventricle.

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Figure 2


Figure 2. 

Axial slices on heart level from bottom to top. a, b: the aorta is connected to the right ventricle; the pulmonary artery is connected to the left ventricle (malposition and atrioventricular discordance); c: the aorta is anterior and located at the right side of the pulmonary artery; d: both aortic arch and the thoracic aorta are right-sided. Ao: Aorta; CA: coronary artery; IVC: inferior venae cavae; LA: left atrium; LV: left ventricle; PA: pulmonary artery; RA: right atrium; RV: right ventricle.

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Figure 3


Figure 3. 

3D image using volume rendering technique shows a unique coronary artery providing blood supply for both ventricles. Ao: Aorta; CA: coronary artery; IVC: inferior venae cavae; LA: left atrium; LV: left ventricle; PA: pulmonary artery; RA: right atrium; RV: right ventricle.

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Step analysis leads to a rare condition of corrected transposition of great vessels with and situs inversus: Inversus, D-Loop, D-malposition (I, D, D).

The patient underwent successful surgical intervention (plasty of tricuspid valve) with relief of dyspnea at three-month follow-up.

MDCT is a new attractive approach to assess complex congenital heart disease. Intracardiac structures may be identified with their anatomic characteristics and with their own connections. 3D visualisation may help planning surgical interventions.

Conflict of interest statement

None.



© 2010  Published by Elsevier Masson SAS.
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