Another day on cardiology! We have a patient on our service who was born with Transposition of the Great Arteries, D-type. There are two types, D and L, and they are determined by the malrotation of the heart during embryology. L (levo) means the ventricles flip-flopped, D (dextro) means the arteries flip-flopped. L is compatable with life, D is not...unless you have R-L heart shunting via an atrial septal defect/ventricular septal defect. You can see below that D-TGA has two separate circuits - one that goes to the lungs and one that goes to the rest of the body. So the blood going to the body never gets oxygenated, as it runs separately from the lung circuit. That is, unless there is hole in between the atria and/or ventricles, which would allow some of the blood to be exchanged between the two circuits. This patient has the D type, and he is middle-aged. He suffers from heart failure now, but considering how poor his odds were stacked against him when he was a baby, I'd say he's been a fairly lucky guy. I'm going to try and speak with him tomorrow. I'm sure he has such an interesting story to tell!
Normal Heart Anatomy:
D-Transposition of the Great Arteries
A schematic of the blood flow in a normal heart and a heart with D-TGA:
Marley went to doggy daycare today. I know, I know, it's silly and she's just a dog blah blah blah but she came home exhausted and with her tail wagging. She had a great time today. And since I can't spend much time with her (and a tiny little walk isn't enough to keep her entertained), I think it's fair for her to spend some time with other dogs. And she loved it! Now I have a snuggley puppy dog curled up on my lap while I read about endocrine and metabolic disorders and answer a set of UWorld questions. Which is perfect.
I forgot to post these photos of Marley from the snowfall at the weekend. Isn't she adorable!?
Right. Back to work I go!
Reference:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002535/
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