Bowled over by posterior Transposition

Background: Transposition of Great arteries (TGA) with posteriorly placed aorta is a rare entity with an incidence of less than 1%. Van Praagh et al. had first described 4 cases with posterior transposition. With 25 cases of this entity reported from all over the world and no case reported from Indian subcontinent, we are reporting a case of 2-month-old male child with TGA, subaortic ventricular septal defect (VSD), posteriorly placed aorta (P) and pulmonary arterial hypertension (PAH). Case Report: A 2-month-old male child, presented with cyanosis and fast breathing. The echocardiography revealed TGA, moderate subarterial VSD, multiple muscular VSDs, posteriorly placed aorta with aortomitral continuity and PAH. Arterial switch operation was done without the Le Compte procedure and septal defects were closed by trans aortic approach. Conclusion: We conclude that TGA, with posteriorly placed aorta is an anatomic entity with anecdotal case reports. The diagnosis of this entity in fetal life and preoperative echocardiography is important for diagnosis and surgical approach.