Criss-cross heart: Twisted anatomy by cardiovascular magnetic resonance

h o s c D a v A 27-year-old male with known congenitally corrected transposition of the great arteries was referred for further workup due to increasing arrhythmias. Cardiovascular magnetic resonance (CMR) showed situs solitus and atrioventricular (AV) and ventriculoarterial (VA) discordance, with the aorta lying anteriorly and to the right of the pulmonary trunk (Figure 1). An unusual alignment was found, with the right and left ventricular inflow tracts aligned almost perpendicular to one another, precluding imaging all four chambers in one plane. The systemic right ventricle was relatively hypoplastic and lay superior to the subpulmonary left ventricle. The findings were typical of a previously unnoticed criss-cross atrioventricular arrangement. A large nonrestrictive ventricular septal defect and severe pulmonary stenosis were also present;