A Case Of Congenitally Corrected Transposition Of Great Arteries Of Elderly Male: A Rare Event

Abstract

 Background:Congenitally corrected transposition of the great arteries (CCTGA) is a rare congenital cardiac anomaly, accounting for less than 1% of all congenital heart defects. It features both atrioventricular and ventriculoarterial discordance, resulting in physiologically corrected circulation. Despite this functional correction, the morphologic right ventricle supports systemic circulation, predisposing patients to progressive ventricular dysfunction, tricuspid valve regurgitation, and conduction system abnormalities. While often diagnosed in childhood when associated with other cardiac anomalies, isolated CCTGA may remain clinically silent and undiagnosed until adulthood or even late life.

Case Presentation:We report the case of a 53-year-old male who presented with a 7-month history of breathlessness. He was nonhypertensive, nondiabetic, and afebrile with stable vital signs. Clinical examination revealed parasternal heave, a loud second heart sound, and a diastolic murmur at the tricuspid area. Transthoracic echocardiography revealed classic features of CCTGA, including atrioventricular and ventriculoarterial discordance, global left ventricular hypokinesia, moderate systolic dysfunction with an ejection fraction of 35–40%, and severe tricuspid regurgitation. Electrocardiogram findings showed evidence of atrioventricular conduction abnormalities. The patient was managed conservatively with diuretics, ACE inhibitors, beta-blockers, nebulization, and supportive therapy. He responded well to medical management and was discharged in a stable condition with outpatient follow-up.

Conclusion:This case emphasizes the importance of considering congenital heart diseases like CCTGA in adult patients presenting with nonspecific cardiac symptoms. Elderly patients with asymptomatic or minimally symptomatic CCTGA may remain undiagnosed for years. Individualized medical management and routine follow-up are essential for optimizing outcomes and monitoring for progressive ventricular dysfunction or arrhythmias.