Isolated congenitally corrected transposition of the great arteries with ...

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Medical Center at Dallas (Tandon, Bose, Yoon, Schussler); the Jack and Jane. Hamilton Heart and Vascular .... 4. Ismat FA, Baldwin HS, Karl. TR, Weinberg PM.
Isolated congenitally corrected transposition of the great arteries with dextroversion discovered incidentally in a patient with cocaine-induced acute myocardial infarction Anumeha Tandon, MD, Rahul Bose, MD, Anthony D. Yoon, MD, and Jeffrey M. Schussler, MD

Complex cardiac congenital anomalies can occasionally be found in adult patients who have no knowledge of their condition. Here we present the case of a 27-year-old man with cocaine-induced acute myocardial infarction in whom an isolated congenitally corrected transposition of the great arteries with dextroversion was discovered incidentally.

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hile congenital anomalies are often left to subspecialists in the adult congenital arena, familiarity with them is important for Figure 1. Electrocardiogram demonstrating a reversal of the P-wave axis (inverted P waves in leads I, AVR, and AVF; arrow) the general cardiologist. When with reversal of progression of R waves across the entire precordial leads (V1–V6). these patients present in association with other, more common conditions, evaluation can anterior descending artery, but in a conformation that would be be more challenging. considered “opposite” of normal anatomy. The opposite coronary artery appeared similar in conformation to a right coronary CASE DESCRIPTION artery, but also had an “opposite” course (Figure 3). A 27-year-old man presented with chest pain. A loud systolic A transthoracic echocardiogram (with images obtained primurmur was heard at the right sternal border, and a rightward marily from right-sided windows) revealed an aorta originating displaced point of maximal impact was noted. The admission from a morphologic right ventricle (systemic ventricle) and the electrocardiogram showed prominent R waves in V1, with an pulmonary trunk from a morphologic left ventricle (pulmonary inverted P-wave axis, and reverse R wave progression across the ventricle). These findings were confirmed by cardiac computed precordium (Figure 1). A chest radiograph demonstrated a righttomography (Figure 4). Abdominal ultrasound showed normally ward-pointed heart, prominent right-sided chambers, and the oriented viscera confirming situs solitus (normal orientation absence of the usual aortic and pulmonary contours (Figure 2). of the viscera). The patient was treated medically for cocaine The urine was positive for cocaine. The patient’s troponin level intoxication and was ultimately discharged in good condition. was 55 ng/mL. At urgent cardiac catheterization, the ventriculogram in the left anterior oblique position disclosed the heart From the Department of Internal Medicine, Division of Cardiology, Baylor University pointing toward the right hemithorax, suggesting dextrocardia Medical Center at Dallas (Tandon, Bose, Yoon, Schussler); the Jack and Jane or dextroversion. Angiography showed no coronary narrowing, Hamilton Heart and Vascular Hospital, Dallas, Texas (Tandon, Yoon, Schussler); but demonstrated “mirror image” epicardial coronary arteries. and Texas A&M College of Medicine (Schussler). The most anterior coronary artery coursed toward the right side Corresponding author: Jeffrey M. Schussler, MD, 621 N. Hall Street, Suite 400, of the body and covered a distribution similar to that of a left Dallas, TX 75226 (e-mail: [email protected]).

Proc (Bayl Univ Med Cent) 2016;29(2):171–173

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Figure 2. Chest radiograph demonstrating a rightward-oriented heart, with the morphologic left ventricle (LV) pointed towards the right. There is loss of the normal aortopulmonary contours (arrowhead), and this area appears “flat.” The gastric bubble is noted under the left hemidiaphragm, indicative of situs solitus (normally oriented viscera).

DISCUSSION Congenitally corrected transposition of the great arteries (CCTGA) is a rare (