Radiological and clinical conflicts in a case of transposition of the great arteries with multiple associated comorbidities

Abstract

Background. Transposition of the great arteries is an embryological misplacement of the Aorta and the trunk of the Pulmonary Artery, in which the Aorta rises from the right ventricle, while the pulmonary trunk continues the left ventricle, thus creating two parallel vascular systems. This situation is not compatible with life in the absence of a communication between the two systems (e.g. Ventricular septum and/or atrial septum defect, persistence of the arterial duct etc.) which will allow the mixing of oxygen-rich blood with deoxygenated blood. In order for the patients to survive, this congenital heart disease has to be treated as soon as possible. In some circumstances the surgery can be post-poned by using prostaglandines to keep the arterial duct open. Considering this information, we decided to look upon a case of TGA with multiple comorbidities and evaluate the role of radiologic and ultrasound(US) investigations in decisions regarding the tempos of the multidisciplinary surgical interventions. Case report. We will present the case of a newborn female, prenatally diagnosed with TGA, who was transferred from another clinic, where an ileostomy was performed, to temporarily treat her inability to feed. She associated a diaphragmal hernia, metabolic uncompensated acidosis, aenemia, elevated respiratory rate, fever and decrease of SpO2. She was treated with PGE1 prior to the surgical interventions which took place in our clinic. After her admission paraclinics confirmed the TGA and diaphragmal hernia through repeated radiographies, and identified the need of closing the ileostomy and reconstructing the digestive tract, due to the presence of peritonitis seen during ultrasound investigations. The patient has undergone a complex multidisciplinary surgical intervention, with the aim of simultaneously fixing all the cardiac and digestive abnormalities through toracotomy aswell as laparotomy. The decision ofsuch an intervention was taken upon evaluating the results of imagistic investigations in a multidisciplinary team. Conclusions. Deciding upon the tempos and complexity of surgical interventions in fragile patients require great team communication and decision making, using all the information available. Thus, radiologic investigations tend to be the centre of these decisions with the amount of information they provide and help guide the surgical team.