CASE HISTORY

Born 1 month premature. Discharged on the 10th day without any abnormality having been noted and certainly without overt cyanosis. A month later the child was brought back markedly cyanosed with in-drawing of the lower ribs and difficulty in breathing. There was a loud systolic murmur over the whole praecordium. Femoral pulses palpable. Air entry diminished in right upper and left lower zones. A diagnosis was made of bronchopneumonia and congenital heart disease and the child was treated with antibiotics and oxygen. She was seen on several occasions by a doctor who noted differential cyanosis with pink feet and blue head. On the strength of this observation a diagnosis of transposition with patent ductus was made. In spite of treatment the child only improved temporarily, relapsed, became cyanosed and died.

PATHOLOGY

Heart 135mmx135mmx60mm. The heart and great vessels and part of the lungs have been mounted. Viewed from the front the two ventricles are of equal thickness and there is a ventricular septal defect (marked by a blue rod). The two atrio-ventricular valves appear normal. There is complete transposition of the great vessels, the right ventricle giving rise to the aorta and the left ventricle to the pulmonary artery. The latter has been opened at the back of the specimen and near the middle a patent ductus can be seen connecting aorta and pulmonary artery. There is a moderate narrowing of the aorta, hardly amounting to a coarctation, just on the proximal side of the ductus.