Echocardiographic recognition of a criss-cross heart with double outlet right ventricle
A 2 month old female infant, weighing 3.7kg presented with history of breathlessness, feeding difficulty and cyanosis. She was a second product of non-consanguineous marriage and born by normal vaginal delivery. There was no family history of congenital heart disease. Physical examination was remarkable with evidence of pallor, cyanosis and dysmorphic facies. Her heart rate and respiratory rates were 154/min. & 60/min. respectively. Blood pressure was recorded at 75/35 mmHg and oxygen saturation 85% in room air. There was evidence of respiratory distress. All the peripheral pulses were well felt. Cardiac auscultation revealed normal first and second heart sound along with a grade 3/6 ejection systolic murmur audible best at the left upper parasternal area. The third heart sound was audible.\nChest roentgenogram revealed an enlarged heart (cardiothoracic ratio 0.6) with pulmonary plethora. The two-dimensional echocardiography, subcostal coronal views demonstrated the connection of the left-sided left atrium and the right-sided left ventricle through the mitral valve and the right-sided right atrium to be connected to the left-sided right ventricle through the tricuspid valve by anterior angulation of the transducer. It also shows the two great arteries arising from the right ventricle ().\n2-D and color Doppler imaging revealed the crossing of the atrioventricular connections. Short-axis views shows the right ventricle was superior and left ventricle was inferior with horizontal position of the ventricular septum ().\nThe standard 4-chamber view was not showing simultaneously all four chambers and both atrioventricular valves ().\nParasternal short axis view shows malposed great arteries ().\nA large size inlet type of ventricular septal defect (bidirectional shunt) and a moderate size ostium secundum atrial septal defect (bidirectional shunt) were present. Biventricular function was normal.