Adaptation of the systemic right ventricle in a congenitally corrected transposition of the great arteries.

A 50-year-old woman with a history of mild exertional dyspnea for several years was consulted for preoperative cardiovascular evaluation as a result of an abnormal ECG. Physical examination revealed a blood pressure of 154/90 mm Hg and a regular pulse rate of 84 beats per minute. Cardiac auscultation noted a grade 2/6 systolic murmur at the apex and the lower left sternal border. No peripheral cyanosis or clubbing of fingers was noted. Her resting ECG showed a sinus rhythm with a normal PR interval, left axis deviation, Q waves in the inferior leads, and left ventricular hypertrophy with ST-T change (Figure 1). Transthoracic echocardiographic segmental analysis of apical 4-chamber view revealed left atrium entered a morphological right ventricle and right atrium entered a morphological left ventricle (atrioventricular discordance; Movie I in the online-only Data Supplement). There was a moderate-to-severe tricuspid regurgitation from morphological right ventricle into left atrium (Movie II in the online-only Data Supplement). The long axis view showed the morphological left ventricle entering into a pulmonary artery with its left and right branches (Movie III in the onlineonly Data Supplement), and identified aorta by the presence of coronary artery from sinus of Valsalva which received the severely hypertrophied morphological right ventricle (ventriculoarterial discordance; Movie IV in the online-only Data Supplement). This double discordance resulted in a congenitally corrected transposition of the great arteries (ccTGA). Real-time 3-dimensional echocardiograms identified the morphological characteristic of the 4 chambers and great arteries (Figure 2, Movies V and VI in the online-only Data Supplement). Cardiac multi-detector computed tomography scan revealed the anatomic left anterior descending and posterior