The typical radiologic and angiocardiographic features of complete transposition of the great vessels with the aort a arising anteriorly from the anatomic and functional right vent ricle, and the pulmonary artery post eriorly from the anat omic and fun ctional left ventricle, are well known (1–6). With the rapid st rides which have taken place in the surgical correction of this anomaly, recognition of obstruction to the outflow tract of the left vent ricle has become increasingly important. A previous report dealt with the pathological findin gs in 23 specimens with this condition (7). Both valvular and subvalvular types of left vent ricular outflow tract obstruction were identified (Fig. 1). The subvalvular va riety exhibited three different appearances: (a) a fibromuscular tunnel found only with a ventricular sept al defect, (b) a fibrous ring or diaphragm found with and without a vent ricular septal defect, and (c) subvalvular muscular narrowing caused by bul ging of the ventricular septum into the cavity of the left ventricle found with and without a ventricular septal defect. It was pointed out that whereas significant obstruction to the pulmonary blood flow resulted from valvular, subvalvular fibromuscular tunnel or subvalvular diaphragm, the obstructionca used by septal bulging was probably mild to moderate. The present st udy was undertaken to evaluate the radiologic and angiocardiographic features in complete transposition of the great vessels, with obstruction to the outflow tract of the left ventricle. Material And Methods The angiocardiograms of 200 patients with complete transposition of the great vessels were reviewed (8). Twenty-eight had an giocardiograms which demonstrated narrowing to the left ventricular outflow tract. Five had an intact vent ricular septum (Group I ), while 23 had an associated septal defect (Group II). Pathological specimens were av ailable in 8 cases, 2 in Group I and 6 in Group II. The ages ranged from six days to nin e and a half years at the time the st udies were carried out. There were 17 males and 11 females. Angiocardiograms in the ante ropost erior and lateral projections were available for all. The contrast material was injected into both vent ricles in 18 cases, into the right ventricle only in 7, the left ventricle in 2, and the left atrium in 1. The data were recorded in cine film in 22 cases, roll or cut film in 4, and on both at different catheter studies in 2. The findings were evaluated under the following headings: 1. 1. Chest roentgenograms 2. 2. Type of left ventricular outflow tract obstruction 3. 3. Size of the aorta and pulmonary artery 4. 4. Position of the aorta to the pulmonary artery 5. 5. Position of the ventricles
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May 1, 1982
M L Apuzzo + 6
Open Access