Hemitruncus with large patent ductus arteriosus simulating d-transposition of great arteries

Abstract

Transposition of great vesselsAnomalous right pulmonary artery a b s t r a c t This report describes a rare case with hemitruncus with large left sided patent ductus arteriosus with severe pulmonary hypertension with reversal of shunt across patent ductus simulating transposition of great arteries. The case illustrates the role of echocardiography and cardiac multidetector CT in diagnosing such complex congenital heart disease.A 40-day-old female baby was referred for evaluation of repeated respiratory tract infection and hurried breathing and progressive weight loss. On clinical examination she was underweight (2.5 kg) and had central cyanosis. The respiratory rate was 55/min and heart rate was 175/min. Oxygen saturation was 76%. Precordial examination revealed loud second sound and mid systolic murmur at pulmonary area. There was S3 gallop. The electrocardiogram revealed right ventricular hypertrophy with right axis deviation. A chest roentgenogram showed marked cardiomegaly with a cardiothoracic ratio of 70% and bilateral increased pulmonary vascularity.Transthoracic echocardiography showed situs solitus with levocardia. There was biventricular dilatation. The subcostal 5 chamber view showed a great artery arising from the left ventricle which was branching at short distance from the origin (Fig. 1 A, Video 1). In short axis view another nonbranching great vessel was seen arising from the right ventricle (Fig. 1B, Video 2). In a modified subcostal view the great artery arising from the right ventricle appeared to continue as descending thoracic aorta (Fig. 1C) which was later confirmed to be large PDA connecting LPA and descending thoracic aorta on CT aortogram. The origins of