Transposition of the great vessels physical examination
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Transposition of the great vessels Microchapters |
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Differentiating Transposition of the great vessels from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Cafer Zorkun, M.D., Ph.D. [3]; Keri Shafer, M.D. [4]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [5]
Overview
Physical Examination
Heart
Palpation
There is a prominent impulse at the LLSB (the RV which is actually the morphologic LV).
Auscultation
The murmur of a large PDA in d-TGA, is usually systolic, seldom continuos, due to the almost exclusive flow during systole from the aorta to the pulmonary artery.
The first heart sound (S1) is normal in intensity and splitting because the PR interva and ventricular activation is normal. Due to the anterior location of the aorta, the second heart sound (S2) is accentuated and is usually single.
Systolic murmurs are absent in neonates unless a subpulmonic stenosis is present. Short midsystolic murmur originate in the anterior aorta when hypervolemia is present. When the pulmonary vascular resistence is low, a midsystolic murmur is originated in the posterior pulmonary artery, but the murmur is dump by the anterior aorta.
A VSD murmur (holosystolic)is absent at birth, until the pulmonary vascular resistence fall. A subsequent increase in pulmonary resistence shortens and later abolishes the murmur.
Extremities
Symmetric cyanosis is the main characteristic in physical appearence of patients with d-TGA, inadequate mixing, and low pulmonary arterial blood flow. Delayed mild cyanosis, and the apearence of congestive heart failure accompanies non-restrictive VSD.
Reversed differential cyanosis (feet less cyanotic than hands) can be a manifestation in patients with d-TGA and large patent ductus arteriosus that has develop early pulmonary vascular disease, reversing the ductal flow if the patient has survived. At this poin in time, the pulmonary arterial blood of high oxygen content enters the aorta and is selectively distribuited to the lower extremities.