Rethinking the "D-" and " L-" prefix paradigm for transposition

The prefixes "D-" and "L-" are widely used as shorthand descriptors for the segmental connections in transposition of the great arteries (TGA), yet their original intent was solely to indicate the spatial position of the aortic root relative to the pulmonary trunk at the level of the semilunar valves and not the underlying atrioventricular (AV) or ventriculo-arterial (VA) connections. Yet this usage persists widely in clinical and imaging practice. We present an illustrative case of TGA with concordant AV and discordant VA connections in which the aortic root is levoposed, a configuration that highlights how prefix-only labeling generates inaccurate descriptions and scope for miscommunication among professionals. The case highlights that aortic position is not the defining feature of the segmental connections in the setting of transposition. Full segmental description is necessary to provide the complete picture.