Anatomical correction of transposition of the great vessels, atrioventricular septal defect and subpulmonary obstruction in an adult

Abstract

An 18 year old female patient was admitted with cyanosis from birth and easy fatigability since 5 years of age. She had been having palpitations for the past 2 years but no medical opinion was sought. An episode of haemoptysis prompted her to seek medical advice. There was no other positive medical or surgical history and the family history was non-contributory. On examination, the patient appeared well nourished and had cyanosis and Grade III clubbing of the finger and toe nails. Blood pressure was 110/80 mm Hg and all peripheral pulses were well palpable. Jugular venous pressure was not raised. Auscultation of the chest revealed a loud second heart sound with a soft and delayed pulmonary component. There was a grade 3 /6 ejection systolic m u r m u r in the third and four th intercostal space in the left parasternal region and a separate grade 3/6 holosystolic murmur at the cardiac apex. Plain radiograph of the chest revealed prominent bronchovascular markings and a narrow pedicled heart wi th egg-on-s ide appearance . There was mi ld cardiomegaly. Electrocardiogram revealed right axis