Background/Aim:Transposition of the great arteries (TGA) is traditionally classified as a “conotruncal heart defect”, implying that TGA evolves from abnormal development of the outflow tract (OFT) of the embryonic heart. However, recently published genetic data suggest that TGA may be linked to laterality gene defects rather than OFT gene defects. The aim of our study was to clarify whether there is any statistically significant link between TGA and clinically diagnosed laterality defects (heterotaxy).Methods:Retrospective cross-sectional analysis of 533 patients diagnosed with TGA at our cardiac center over a period of 13 years (2002-2015). Hospital informatics and digital data recording systems were used for collecting patients' data and all patients were reviewed to check the echocardiograms for verification of the diagnosis, type (TGA, congenitally corrected TGA (ccTGA), and levo-position of the great arteries (LGA)), complexity of TGA, and all other variables (e.g., abdominal organ arrangement, cardiac position, presence or absence of other cardiac defects).Results:Of 533 TGA patients, 495 (92.9%) had the usual arrangement of the internal organs, 21 (3.9%) had mirror-imagery, 7 (1.3%) had left and 10 (1.8%) had right isomerism. 444 (83.3%) patients had TGA. The number of patients who had usual visceral arrangement in each TGA type was: 418 (94.1%) in TGA, 49 (92.4%) in ccTGA, and 28 (77.7%) in LGA. 6 (1.4%) TGA patients, 4 (11.1%) patients with LGA were found to have right isomerism, while no ccTGA patient presented with this asymmetry. 4 (0.9%) TGA patients, 1 (1.9%) ccTGA patient and 2 (5.6%) patients with LGA had left isomerism. Heterotaxy (mirror-imagery, left and right isomerism) was more associated with LGA than TGA or ccTGA with a statistically significant difference (P value of 0.001).Conclusion:In contrast to recently published genetic data, our morphological data do not disclose a significant link between TGA and heterotaxy.
One of the well-known complications of immunosuppression is herpes simplex esophagitis and it is rarely found in immunocompetent patients. We present a case of a 75-year-old female known case of diabetes mellitus, hypertension and dyslipidemia with two-month history of dysphagia and odynophagia to solid mainly and cough tinged with blood. On esophagogastroduodenoscopy there was right side of oropharynx ulcer, edema and focal erythema with compression on the esophageal entrance. Biopsy confirmed esophagitis and findings characteristic of herpes simplex virus infection. After the diagnosis was made, the patient was treated with prednisone for 10 days and famciclovir for 14 days and showed significant improvement in a period of nearly 2 weeks. We recommend antiviral treatment even for immunocompetent patients for the clear acceleration of the recovery time and prevention of possible complications.
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