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Corrected transposition of the great arteries simulating coronary heart disease in adults
Insights
Chest pain in adults with corrected transposition of the great arteries may stem from inadequate coronary reserve in the systemic ventricle. This finding is crucial for understanding coronary artery disease in complex congenital heart conditions.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Cardiac Imaging
Background:
- Corrected transposition of the great arteries (ccTGA) is a complex congenital heart defect.
- Patients with ccTGA can develop symptoms mimicking coronary artery disease.
- Accurate diagnosis of the cause of chest pain in these patients is critical.
Abstract:
Two middle-aged adults with corrected transposition of the great arteries presented with chest pain and dyspnea, initially attributed to coronary arterial disease with left ventricular dysfunction and mitral regurgitation. The clinical diagnosis of coronary arterial disease was supported in these patients by electrocardiographic changes of probable old anteroseptal myocardial infarction and by an abnormal cardiac silhouette on the chest x-ray film suggestive of ventricular aneurysm. Coronary arteriographic studies in both patients showed that the morphologic left coronary artery supplied the venous ventricle, and the right coronary artery supplied the systemic ventricle. Neither patient had coronary arterial luminal narrowing. We propose that anginal chest pain in these patients resulted from inadequate coronary reserve of the morphologic right ventricle functioning as a systemic ventricle.