ECG in ventricular inversion
Absence of q waves in lateral leads and presence in V1 suggests ventricular inversion in levo transposition of great arteries (L-TGA).
Right aortic arch on X-ray chest PA
Side of aortic arch is identified by the tracheal indentation by the arch. The indentation is seen on the right side of the tracheal air column in right aortic arch. The upper thoracic descending aorta will be seen on the right side of the spine in right aortic arch.
X-ray appearance in D-TGA
Egg on side appearance is the classical appearance of the cardiac shadow on x-ray chest PA view in dextro transposition of great arteries (D-TGA). The anteroposterior relationship of aorta and pulmonary artery and thymic hypoplasia contribute to the narrow pedicle in infancy.
Bilateral conus
Bilateral conus is seen in double outlet right ventricule. Conus is manifest as a semilunar valve AV valve discontinuity with the conus tissue in between. In normal heart conus is seen below the pulmonic valve, but not below the aortic valve, so that there is mitral-aortic continuity and tricuspid-pulmonary discontinuity.
Absent conus
Absent conus is seen in D-TGA.
Cor triatriatum
In cor triatriatum there is a superior and inferior chamber with a membrane dividing the left atrium. In cor triatriatum dexter, there is a medial and a lateral chamber.
LV outflow obtruction in D-TGA
Projecting tissue from mitral valve, tricuspid valve or membraneous septum, tunnel like obstruction and systolic anterior motion of mitral valve are some of the mechanisms of LV outflow obstruction in D-TGA.
Rastelli procedure
Rastelli procedure is done in case of D-TGA with LV outflow obstruction as arterial switch is not feasible. Straddling tissue from tricuspid valve across the LV ouflow tract makes Rastelli procedure difficult requiring a modification of the procedure.
Determination of situs from bronchial shadow on X-ray chest
Morphological right bronchus is more vertical and branches earlier while left bronchus is more horizontal and branches later.