Transposition of the great vessels anatomy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Anatomy

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Normally, the morphologic right atrium (RA) is connected to a morphologic right ventricle (RV). The morphologic left atrium (LA) is connected to the morphologic left ventricle (LV). This is called atrio-ventricular concordance.

In a normal heart, the great arteries (aorta and pulmonary arteries) are concordant with the morphologic LV and RV. This is termed ventriculo-arterial concordance. In addition, the aorta and pulmonary trunk ascend in a spiral relationship.

In the TGA the aorta arises from the morphologic right ventricle via a subaortic infundibulum and the pulmonary artery arises from the morphologic left ventricle, without a subpulmonary infundibulum. These ventriculoarterial connection is known as ventriculoarterial discordance. As a consequence, there is a a fibrous continuity between the mitral and pulmonary valve, but no continuity between the tricuspid and aortic valve.

The abnormal origin of the great arteries results in an altered spiral relationship. Therefore, the aorta and pulmonary artery run parallel to each other, producing circulation functioning in parallel, instead of normal circulation functioning in series.

d-TGA is also referred to as complete or uncorrected transposition of the great arteries identifying the single discordance between ventricles and great arteries, whereas l-TGA is referred to as congenitally corrected transposition, identifying a double discordance (atrioventricular and ventriculoarterial).