Congenitally Corrected Transposition of the Great Arteries Presenting in a Nonagenarian

An 82-year-old woman presented with recurrent syncope. Clinically, she had a slow rising pulse, right parasternal heave, and an ejection systolic murmur loudest at the right sternal edge with a quiet pansystolic murmur at the apex. ECG demonstrated prolonged PR interval and extreme leftward axis. Transthoracic and transesophageal echocardiography revealed atrioventricular and ventriculoarterial discordance, suggesting congenitally corrected transposition of the great arteries (ccTGA). The systemic right ventricle (RV) was hypertrophied and mildly dilated with normal systolic function, but there was severe subvalvular stenosis with a peak velocity of 4.5 m/s (Figures 1 and 2⇓). The aortic valve was trileaflet and anterior to the pulmonary valve, and there was mild left atrioventricular valve regurgitation. Figure 1. Transthoracic echocardiographic images. Shown are representative images from transthoracic echocardiography at …