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Case History :

6 month baby girl presented with frequent respiratory tract infection and failure to thrive .
On examination she was dyspnic and cyanosed and had cold extremities.
On auscultation she had tachycardia with ejection systolic murmur.

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Investigation Reports :

Click on the link below to view the Image/Movie and Description

Discussion :

The Catheter course was RFV->IVC->AZYGOS V->SVC->RA; RA->ASD->LA->R.
The pressure study showed Normal PCW Pressures, Normal PA Pressures.No mean gradient across ASD, 10mm Hg peak gradient across PV in PA to RV pull back.
Saturation study showed FA SAT 72%.
In view of the above findings patient was diagnosed to have TGA with Right Aortic arch. In such cases ASD is essential for survival due to admixture and maintenance of cardiac output. This child had ASD and hence survived after six months. In absence of ASD or any communication between atria or ventricle or great vessel , survival is rare beyond 1st week. If diagnosed in 1st week patient is subjected to Balloon Atrial Septostomy for creating admixture as a pallative procedure. However definitive treatment for such a complex congenital disease is Atrial switch operation or Arterial switch operation.

Dr.Prasad Reddy
Mediciti Hospitals