THE ROENTGENOLOGIC FINDINGS IN COMMON VENTRICLE WITH TRANSPOSITION OF THE GREAT VESSELS.

Abstract

The roentgenologic findings in corrected transposition and complete transposition of the great vessels have received sufficient attention to make them relatively accessible to clinical identification (1–7). Little attention, however, has been directed to the radiologic findings of common ventricle, a condition which, while sharing a somewhat similar interrelationship between the great vessels, does not have the same intracardiac characteristics. The purpose of this communication is to describe the roentgenologic findings in the 16 cases of common ventricle available to the authors. As the diagnostic and surgical problems concerned with common ventricle are specific, it is essential that we define the condition as used in this report. In common ventricle with transposed great vessels, there is one ventricular chamber into which both (when there are two) atrioventricular (AV) valves empty. Lying anteriorly at the basal portion of the ventricle, a subdivision, the infundibular chamber, communicates with the main part of the common ventricle. The pulmonary trunk arises from the ventricular chamber, while the aorta arises in a transposed position from the infundibulum. The AV valves do not communicate with the infundibular chamber (Fig. 1). In each case of common ventricle studied at necropsy and angiocardiography, an infundibular chamber was present. This was located anteriorly at the base of the heart in one of two positions. When the infundibulum was at the right aspect of the base, it was considered to be in a “noninverted” position, when at the left aspect, it was considered “inverted” (Fig. 1). These terms seem appropriate since common ventricle with infundibular inversion is the mirror image of common ventricle with noninverted infundibulum. In some cases of common ventricle, additional pathologic conditions may occur, including obstruction to pulmonary flow caused by pulmonary valvular or sub-pulmonary stenosis. As reported by us in an earlier communication (8), common ventricle may occasionally be associated with other abnormalities of the AV valves, such as common AV valve, tricuspid atresia, or mitral atresia. This report, however, deals solely with patients having two functioning AV valves. It is essential, we believe, not to confuse the condition under discussion with others in which there is transposition of the great vessels. Our definition of common ventricle with inversion of the infundibulum does not include corrected transposition, a condition with two ventricles, which anatomically allows a normal route of blood flow. Neither does our definition of common ventricle with noninversion of the infundibulum include complete transposition, a condition with two functioning ventricles, the aorta arising entirely from the right ventricle and the pulmonary trunk entirely from the left ventricle.