Radiology, Vol 134, 53-59, Copyright © 1980 by Radiological Society of North America
Recognition of developing left ventricular outflow tract obstruction in complete transposition of the great arteries
IL Tonkin, M Sansa, LP Elliott and LM Bargeron Jr
In the months following balloon atrial septostomy for complete
transposition of the great arteries (TGA), clinical deterioration is often
ascribed to closure of the septostomy. Of 16 neonates with TGA, 5 showed
early clinical deterioration. Each had an adequate septostomy at operation.
Deterioration was characterized clinically by increasing cyanosis and
radiographically by progressive diminution in pulmonary vascularity.
Subsequent catheterization and axial cineangiography demonstrated that
pulmonary flow had decreased, probably secondary to a progressive form of
left ventricular outflow tract obstruction (LVOTO) characterized by bulging
of the ventricular septum with mitral valve apposition. It is important to
recognize this phenomenon as an aid in predicting which children will need
early surgical intervention.
