Transposition of the Great Arteries and Coarctation of the Aorta in an Infant Presenting with Bronchiolitis: An incidental finding

Abstract

abstract:The transposition of the great arteries (TGA) is a complex congenital heart disease which usually presents as cyanosis in neonates with limited mixing between the systemic and pulmonary circulatory systems. A delayed diagnosis of TGA can lead to ventricular failure. We report a six-week-old infant who was admitted to the paediatric Intensive Care Unit of the Royal Hospital, Muscat, Oman, in 2016 for bronchiolitis. During admission, she was incidentally diagnosed with TGA and coarctation of the aorta. Postnatal screening, including the use of pulse oximetry, plays a significant role in avoiding a late diagnosis of TGA; however, this screening tool is not widely used in Oman. Moreover, the common practice of applying a pulse oximetry probe only to the foot may have been limited in the current case due to the reverse differential saturation between the upper and lower limbs caused by this particular combination of lesions.

Anomalous Origin of the Right Subclavian Artery in a Patient with D-transposition of the Great Arteries

“…This unexpected finding caused confusion in the diagnosis; with this in mind, the presence of an anomalous RSCA should be considered prior to surgery. In patients with d-TGA, the deoxygenated blood from the right ventricle is pumped into the systemic circulatory system through the aorta to supply the head, neck, and upper limbs, while oxygenated blood from the left ventricle is pumped into the pulmonary circulation via the pulmonary artery [3]. This leads to higher saturation in the lower limbs than in the arms and generally suggests reversed differential cyanosis.…”