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Diagnosed corrected transposition of great arteries after cesarean section: A case report
Naoki Ichii1, Toshiyuki Kakinuma2, Atsushi Fujikawa3
1Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Tochigi 329-2763, Japan.
Insights
Corrected transposition of the great arteries (cTGA), a congenital heart defect, can lead to acute heart failure in postpartum patients. Early detection and management are crucial for improved outcomes in these complex cases.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Maternal-Fetal Medicine
Background:
- Corrected transposition of the great arteries (cTGA) involves reversed ventricular and arterial positions, often leading to systemic circulation overload and heart failure.
- This condition typically presents a poor prognosis, necessitating careful monitoring, especially in vulnerable populations.
- Pregnancy can exacerbate underlying cardiac conditions, posing risks to both mother and fetus.
Observation:
- A 36-year-old postpartum patient, 18 days after an elective cesarean section, presented with acute heart failure symptoms including dyspnea and bilateral pleural effusions.
- Initial assessment revealed pedal edema and reduced oxygen saturation (SpO2 91%).
- Computed tomography confirmed the presence of cTGA without other identified cardiac anomalies.
Findings:
- The patient was diagnosed with acute heart failure secondary to undiagnosed cTGA.
- Medical intervention led to significant improvement in edema and pleural effusions.
- The patient was discharged on postoperative day 9.
Implications:
- Highlights the importance of considering congenital cardiac malformations in postpartum patients presenting with heart failure symptoms.
- Suggests the need for enhanced cardiac screening during perinatal care, particularly in cases with risk factors.
- Emphasizes prompt diagnosis and management of cTGA in pregnancy to prevent severe maternal morbidity.
Background:
Corrected transposition of the great arteries (cTGA) is a cardiac malformation in which the ventricular and arterial-ventricular positions in the heart are doubly reversed. In general, this defect puts a load on the systemic circulation and causes heart failure, resulting in a poor prognosis. This article reports a case of cTGA detected in a patient with post-caesarean pregnancy who had undergone elective caesarean section and was experiencing an episode of acute heart failure.
Case Summary:
This was the case of a 36-year-old gravida 3 para 1 woman. No problems were noted in the puerperal course following the previous pregnancy. The current pregnancy was also uneventful. An elective caesarean section was performed and the patient was discharged from the hospital 7 d after the operation. On postoperative day 18, the patient became aware of breathing difficulty and presented at a nearby clinic, where she was referred to our institution after bilateral pleural effusions were detected. She was then diagnosed with acute heart failure after noting the presence of a prominent pedal oedema and SpO2 91% (supine position and room air); the patient was promptly hospitalised for close examination and treatment. Although chest computed tomography revealed the presence of cTGA, no other cardiac malformations were observed. Owing to improvements in both the pedal oedema and pleural effusions, the patient was discharged on day 9.
Conclusion:
Close examination should be performed on the premise of congenital cardiac malformation when heart failure symptoms are noted during perinatal control.
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