Chapter 3.26 Double discordance


In this fascinating cardiac malformation, the morphologically left atrium (=pulmonary venous atrium) is connected via a tricuspid valve with the morphologically right ventricle, from which originates the aorta, while the morphologically right atrium (= systemic venous atrium) is connected via a mitral valve with the morphologically left ventricle, from which originates the pulmonary artery. Therefore two discordant connections, atrioventricular and ventriculoarterial (= double discordance), occur in sequence in each side of the heart. The classical definition of “congenitally corrected transposition of the great arteries” derived from the observation that the effects of transposition of the great arteries are “corrected” by the congenital inversion of the two ventricles, with the two circulatory pathways “physiologically” in series, despite the anatomic derangements.


Tricuspid Valve Ventricular Septal Defect Great Artery Atrioventricular Valve Pulmonary Artery Banding 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Ando M, Duncan BW, Mee RBB (2003) Anatomic correction for corrected transposition after pulmonary unifocalization. Ann Thorac Surg 75:1012–1014PubMedCrossRefGoogle Scholar
  2. Bautista-Hernandez V, Marx GR, Gauvreau K, Mayer JE, Cecchin F, del Nido PJ (2006) Determinants of left ventricular dysfunction after anatomic repair of congenitally corrected transposition of the great arteries. Ann Thorac Surg 82:2059–2066PubMedCrossRefGoogle Scholar
  3. Chang DS, Barack BM, Lee HY (2007) Congenitally corrected transposition of the great arteries: imaging with 16-MDCT. Am J Roentgenol 188:W428–430CrossRefGoogle Scholar
  4. Choi BW, Park YH, Choi JY, Choi BI, Kim MJ, Ryu SJ, Lee JK, Sul JH, Lee SK, Cho BK, Choe KO (2001) Using electron beam CT to evaluate conotruncal anomalies in pediatric and adult patients. Am J Roentgenol 177:1045–1049Google Scholar
  5. Corno AF (2000) Surgery for congenital heart disease. Curr Opinion Cardiol 15:238–243CrossRefGoogle Scholar
  6. Corno AF (2002) Surgical treatment of complex cardiac anomalies: the “one and half ventricle repair. Eur J Cardiothorac Surg 22:436–437 (editorial comment)Google Scholar
  7. Corno AF, Bonnet D, Sekarski N, Sidi D, Vouhr PR, von Segesser LK (2003) Remote control of pulmonary blood flow: initial clinical experience. J Thorac Cardiovasc Surg 126:1775–1780PubMedCrossRefGoogle Scholar
  8. Corno AF, Qanadli SD, Sekarski N, Artemisia S, Hurni M, Tozzi P, von Segesser LK (2004) Bovine valved xenograft in pulmonary position: medium-term follow-up with excellent hemodynamics and freedom from calcifications. Ann Thorac Surg 78:1382–1388PubMedCrossRefGoogle Scholar
  9. Delius RE, Rademecker MA, de Leval MR, Elliott MJ, Stark J (1996) Is a high-risk biventricular repair always preferable to conversion to a single ventricle repair? J Thorac cardiovasc Surg 112:1561–1567PubMedCrossRefGoogle Scholar
  10. Dodge-Khatami A, Tulevski II, Bennink GB, Hitchcock JF, de Mol BA, van der Wall EE, Mulder BJ (2002) Comparable systemic ventricular function in healthy adults and patients with unoperated congenitally corrected transposition using MRI dobutamine stress testing. Ann Thorac Surg 73:1759–1764PubMedCrossRefGoogle Scholar
  11. Fratz S, Hauser M, Bengel FM, Hager A, Kaemmerer H, Schwaiger M, Hess J, Stern HC (2006) Myocardial scars determined by delayed-enhancement magnetic resonance imaging and positron emission tomography are not common in right ventricles with systemic function in long-term follow up. Heart 92: 1673–1677PubMedCrossRefGoogle Scholar
  12. Giannico S, Corno AF, Marino B, Cicini MP, Gagliardi MG, Amodeo A, Picardo S, Marcelletti C (1992) Total extracardiac right heart bypass. Circulation 86(Suppl 2):110–117Google Scholar
  13. Giardini A, Lovato L, Donti A, Formigari R, Oppido G, Gargiulo G, Picchio FM, Fattori R (2006) Relation between right ventricular structural alterations and markers of adverse clinical outcome in adults with systemic right ventricle and either congenital complete (after Senning operation) or congenital corrected transposition of the great arteries. Am J Cardiol 98:1277–1282PubMedCrossRefGoogle Scholar
  14. Goo HW, Park IS, Ko JK, Kim YH, Seo DM, Yun TJ, Park JJ, Yoon CH (2003) CT of congenital heart disease: normal anatomy and typical pathologic conditions. Radiographics 23:S147–165PubMedCrossRefGoogle Scholar
  15. Graham TP, Bernard YD, Mellen BG, Celermajer D, Baumgartner H, Cetta F, Connolly HM, Davidson WR, Dellborg M, Foster E, Gersony WM, Gessner IH, Hurwitz RA, Kaemmerer H, Kugler JD, Murphy DJ, Noonan JA, Morris C, Perloff JK, Sanders SP, Sutherland JL (2000) Long-term outcome in congenitally corrected transposition of the great arteries: a multi-institutional study. J Am Coll Cardiol 36: 255–261PubMedCrossRefGoogle Scholar
  16. Hoeffel JC (2001) Congenitally corrected transposition of the great arteries (L-TGA) with situs inversus totalis in adulthood: findings with magnetic resonance imaging. Magn Reson Imaging 19:762PubMedCrossRefGoogle Scholar
  17. Imai Y, Seo K, Aoki M, Shin’oka T, Hiramatsu K, Ohta A (2001) Double-switch operation for congenitally corrected transposition. Pediatr Card Surg Ann Semin Thorac Cardiovasc Surg 4:16–33CrossRefGoogle Scholar
  18. Karl TR, Weintraub RG, Brizard CP, Cochrane AD, Mee RBB (1997) Senning plus arterial switch operation for discordant (congenitally corrected) transposition. Ann Thorac Surg 64:495–502PubMedCrossRefGoogle Scholar
  19. Lembcke A, Koch C, Dohmen PM, Rutsch W, Abbara S, Krug LD, Muehler MR, Rogalla P (2005) Electrocardiographic-gated multislice computed tomography for visualization of cardiac morphology in congenitally corrected transposition of the great arteries. J Comput Assist Tomogr 29:234–237PubMedCrossRefGoogle Scholar
  20. Losekoot TG, Anderson RH, Becker AE, Danielson GK, Soto B (1983) Congenitally corrected transposition. Churchill Livingstone, EdinburghGoogle Scholar
  21. Lundstrom U, Bull C, Wyse RK, Somerville J (1990) The natural and “unnatural” history of congenitally corrected transposition. Am J Cardiol 65:1222–1229PubMedCrossRefGoogle Scholar
  22. Marcelletti C, Maloney JD, Ritter DG, Danielson GK, McGoon DC, Wallace RB (1980) Corrected transposition and ventricular septal defect: surgical experience. Ann Surg 191:751–759PubMedCrossRefGoogle Scholar
  23. Marino B, Corno AF (2003) Spiral pattern: universe, normal heart, and complex congenital defects. J Thorac Cardiovasc Surg 126:1225–1226PubMedCrossRefGoogle Scholar
  24. Mazzera E, Corno AF, Picardo S, Di Donato RM, Marino B, Costa D, Marcelletti C (1989) Bidirectional cavopulmonary shunts: clinical applications as staged or definitive palliation. Ann Thorac Surg 47:415–420PubMedCrossRefGoogle Scholar
  25. Piran S, Veldtman G, Siu S, Webb GD, Liu PP (2002) Heart failure and ventricular dysfunction in patients with single or systemic right ventricles. Circulation 105:1189–1194PubMedCrossRefGoogle Scholar
  26. Scardi S, Pagnan L, Perkan A (2005) Magnetic resonance assessment of an adult patient with congenitally corrected transposition of the great arteries. Ital Heart J 6:939–940PubMedGoogle Scholar
  27. Schwab JO, Ehlgen A, Sommer T (2003) Congenitally corrected transposition of the great arteries in a 70-year-old woman diagnosed using single-detector helical CT. Am J Roentgenol 181:598Google Scholar
  28. Steinhoff JP, Hyslop B, Menon V, Willis PW (2004) Images in cardiology. Congenitally corrected transposition of the great arteries with subpulmonic stenosis. Clin Cardiol 27:551PubMedCrossRefGoogle Scholar
  29. Tulevski II, van der Wall EE, Groenink M, Dodge-Khatami A, Hirsch A, Stoker J, Mulder BJ (2002) Usefulness of magnetic resonance imaging dobutamine stress in asymptomatic and minimally symptomatic patients with decreased cardiac reserve from congenital heart disease (complete and corrected transposition of the great arteries and subpulmonic obstruction). Am J Cardiol 89:1077–1081PubMedCrossRefGoogle Scholar

Copyright information

© Steinkopff Verlag 2009

Personalised recommendations