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en l. posición anterior

English translation: levo-transposition

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22:00 Feb 17, 2018
Spanish to English translations [PRO]
Medical - Medical: Cardiology / Echocardiogram report
Spanish term or phrase: en l. posición anterior
This is from a report of an echocardiogram. The only identifying information on the report is the doctor's name - no patient name, no location, no date - but based on other documents that came with it, I think it's from Cuba, from 2016.
I'm having a hard time figuring out what the "l." is doing in this phrase:
Corazón con conexión AV por doble entrada a ventrículo principal de morfología izquierda que se sitúa a la derecha, inferior y posterior. De este ventrículo emerge la arteria pulmonar con estenosis mixta subvalvular predominante y valvular. El ventrículo secundario, de morfología derecha no tiene entrada, solo cuerpo rudimentario y salida; del mismo emerge la aorta ***en l. posición anterior***. Este VD se sitúa a la izquierdo en posición además antero superior. Existe asa ***l. bulbo ventricular***.
All I have is a blurry PDF of the report, in a sans-serif font. I can't be sure if the character in question is a lower-case L, a lower case i, an upper case I; possibly even a numeral 1.
Note that the combination "l." occurs again in the last paragraph of the text I have presented - equally confusing to me, especially with "asa" a probable typo.
One possibility that occurred to me is that it could be a capital I - with its serifs showing in this font (not in my PDF) - for "izquierdo"? Has anyone run across this specific usage before?
Thanks for your help in advance -
TomWalker
United States
Local time: 11:08
English translation:levo-transposition
Explanation:
I've been thinking about the question and I'm pretty sure that 'levo-transposition' means 'to the left and anterior' (of the pulmonary artery). I would write:

'la aorta ***en l. posición anterior'
'the aorta in levo transposition'

The major anatomic classifications of transposition of the great arteries depend on the relationship of the great arteries to each other and/or the infundibular morphology. In approximately 60% of the patients, the aorta is anterior and to the right of the pulmonary artery (dextro-transposition of the great arteries [d-TGA]). However in a subset of patients, the aorta may be anterior and to the left of the pulmonary artery (levo-transposition of the great arteries [l-TGA]). In addition, most patients with transposition of the great arteries (regardless of the spacial orientation of the great arteries) have a subaortic infundibulum, an absence of subpulmonary infundibulum, and fibrous continuity between the mitral valve and the pulmonary valve.

https://emedicine.medscape.com/article/900574-overview

Normally the aorta is dextro-posed and the ascending aorta is seen along the right cardiac border. In levo-posed (L-posed) aorta, the ascending aorta is on the left border, as in this case. In dextro-transposition of great arteries (D-TGA), aorta is dextro-posed and in levo transposition of great arteries, aorta is levo-posed.

D-transposition is the usual transposition of great arteries, which a cyanotic congenital heart disease with increased pulmonary blood flow (unless there is associated severe pulmonary stenosis – left ventricular outflow tract obstruction). L-transposition is usually a corrected transposition of great arteries with atrioventricular and ventriculoarterial discordance so that right atrial blood reaches the pulmonary artery and left atrial blood reaches the aorta. Hence it is a non cyanotic condition and may be missed unless there are other associated anomalies like ventricular septal defect, pulmonary stenosis or congenital complete heart block, which are the common associations of L-TGA.

https://cardiophile.org/mesocardia-with-l-tga-2/

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Note added at 12 hrs (2018-02-18 10:11:28 GMT)
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'Asa' is 'loop'.

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Note added at 6 days (2018-02-24 17:36:26 GMT) Post-grading
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Thank you, too! Glad to have been of help :-)
Selected response from:

Helena Chavarria
Spain
Local time: 20:08
Grading comment
Thanks so much, Helena. I was on a deadline & just couldn't get a handle on this. Your references & suggestions got me pointed in the right direction.
4 KudoZ points were awarded for this answer



Summary of answers provided
3 +2levo-transposition
Helena Chavarria
Summary of reference entries provided
This might help
Helena Chavarria
Algunas referencias en castellano
Chema Nieto Castañón

Discussion entries: 5





  

Answers


12 hrs   confidence: Answerer confidence 3/5Answerer confidence 3/5 peer agreement (net): +2
levo-transposition


Explanation:
I've been thinking about the question and I'm pretty sure that 'levo-transposition' means 'to the left and anterior' (of the pulmonary artery). I would write:

'la aorta ***en l. posición anterior'
'the aorta in levo transposition'

The major anatomic classifications of transposition of the great arteries depend on the relationship of the great arteries to each other and/or the infundibular morphology. In approximately 60% of the patients, the aorta is anterior and to the right of the pulmonary artery (dextro-transposition of the great arteries [d-TGA]). However in a subset of patients, the aorta may be anterior and to the left of the pulmonary artery (levo-transposition of the great arteries [l-TGA]). In addition, most patients with transposition of the great arteries (regardless of the spacial orientation of the great arteries) have a subaortic infundibulum, an absence of subpulmonary infundibulum, and fibrous continuity between the mitral valve and the pulmonary valve.

https://emedicine.medscape.com/article/900574-overview

Normally the aorta is dextro-posed and the ascending aorta is seen along the right cardiac border. In levo-posed (L-posed) aorta, the ascending aorta is on the left border, as in this case. In dextro-transposition of great arteries (D-TGA), aorta is dextro-posed and in levo transposition of great arteries, aorta is levo-posed.

D-transposition is the usual transposition of great arteries, which a cyanotic congenital heart disease with increased pulmonary blood flow (unless there is associated severe pulmonary stenosis – left ventricular outflow tract obstruction). L-transposition is usually a corrected transposition of great arteries with atrioventricular and ventriculoarterial discordance so that right atrial blood reaches the pulmonary artery and left atrial blood reaches the aorta. Hence it is a non cyanotic condition and may be missed unless there are other associated anomalies like ventricular septal defect, pulmonary stenosis or congenital complete heart block, which are the common associations of L-TGA.

https://cardiophile.org/mesocardia-with-l-tga-2/

--------------------------------------------------
Note added at 12 hrs (2018-02-18 10:11:28 GMT)
--------------------------------------------------

'Asa' is 'loop'.

--------------------------------------------------
Note added at 6 days (2018-02-24 17:36:26 GMT) Post-grading
--------------------------------------------------

Thank you, too! Glad to have been of help :-)

Helena Chavarria
Spain
Local time: 20:08
Native speaker of: Native in EnglishEnglish
PRO pts in category: 12
Grading comment
Thanks so much, Helena. I was on a deadline & just couldn't get a handle on this. Your references & suggestions got me pointed in the right direction.

Peer comments on this answer (and responses from the answerer)
agree  liz askew
1 hr
  -> Liz, thank you for your confirmation :-)

agree  lorenab23: Bravo Helenita, as I mentioned in the discussion section, I learned something new!
17 hrs
  -> So did I ;-) Thank you, Lorena!
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Reference comments


1 hr
Reference: This might help

Reference information:
L = Levo

Levo-Transposition of the great arteries (L-Transposition of the great arteries, also commonly referred to as congenitally corrected transposition of the great arteries (CC-TGA), is an acyanotic congenital heart defect (CHD) in which the primary arteries (the aorta and the pulmonary artery) are transposed, with the aorta anterior and to the left of the pulmonary artery; the morphological left and right ventricles with their corresponding atrioventricular valves are also transposed.

https://en.wikipedia.org/wiki/Levo-Transposition_of_the_grea...

In the case described anatomically corrected transposition of the great vessels is associated with situs inversus. Anatomically corrected transposition is extremely rare, and has not been previously reported with situs inversus. This type of transposition should not be confused with classical corrected transposition. Thus the case examined exhibited a D-bulboventricular loop with L-transposition and atrial inversion, so that blood flow was physiologically incorrect as in classical complete transposition.

http://circ.ahajournals.org/content/46/1/173

SESION ANATOMOCLINICA. VENTRICULO UNICO IZQUIERDO CON ASA L BULBO- VENTRICULAR.

http://bddoc.csic.es:8080/buscarIndice.html?SQLIndice=RF has...

I think I can confirm that L = Levo but I'm afraid I don't know what 'posición anterior' could be. It could be anterior in time or posición.


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Note added at 1 hr (2018-02-17 23:43:26 GMT)
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There are D-loops, L-loops and X-loops.

https://books.google.es/books?id=1164BAAAQBAJ&pg=PA286&lpg=P...

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Note added at 1 hr (2018-02-17 23:45:56 GMT)
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Levo-Transposition of the great arteries
Congenitally corrected transposition of the great arteries (CCTGA) is defined as that condition in which the atria are connected to the opposite ventricle (right atrium to left ventricle, left atrium to right ventricle) and the ventricles are connected to the “wrong” great artery (left ventricle to pulmonary artery, right ventricle to aorta).

Congenitally Corrected Transposition of the Great Arteries
Congenitally corrected transposition of the great arteries (L-TGA), known as congenitally or physiologically corrected transposition of the great arteries, levo-transposition, double discordance, and ventricular inversion, is a rare CHD characterized by both atrioventricular and ventriculoarterial discordance. It accounts for about 0.5% of all CHDs.

Inversion of the ventricles is a major feature of l-TGA which develops when the primitive heart undergoes levo (l)-bulboventricular looping rather than the usual dextro (d)-bulboventricular looping; hence, the alternative designation of corrected transposition as l-transposition. In this condition, the pulmonary artery is located posterior to the aorta, and the coronary arteries and atrioventricular valves also are inverted (Figure 15.9).

https://www.sciencedirect.com/topics/medicine-and-dentistry/...

Helena Chavarria
Spain
Native speaker of: Native in EnglishEnglish
PRO pts in category: 12
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5 hrs
Reference: Algunas referencias en castellano

Reference information:
Es necesario identificar las conexiones ventrículo-arteriales y la relación entre los grandes vasos:
Normalmente la aorta es posterior y se sitúa a la derecha de la arteria pulmonar (D normal); en D (dextro) transposición, la aorta es anterior y se encuentra a la derecha de la arteria pulmonar; y en L (levo) transposición, la aorta es anterior y se mantiene a la izquierda de la arteria pulmonar. La descripción como D o L de la relación entre la aorta y la arteria pulmonar no debe confundirse con la D o L (asa ventricular) de la relación entre los dos ventrículos. Por ejemplo, una transposición no corregida de los grandes vasos en un paciente con situs solitus se denomiará como solitus/D asa ventricular/D transposición (es decir, las aurículas están en situación normal, los ventrículos también –concordancia aurículo-ventricular-, la aorta está a la derecha de la pulmonar, pero en situación anterior, saliendo por tanto del ventrículo derecho: discordancia ventrículo arterial).
https://books.google.es/books?id=Z11uYt6HcH4C&pg=PT75&lpg=PT...

Se define a la atresia tricúspide como la agenesia completa de la válvula tricúspide e inexistencia del orificio correspondiente de forma que no existe comunicación entre la aurícula y ventrículo derecho. Es por tanto, una cardiopatía congénica con conexión atrioventricular y univentricular, en contraste con la normalidad que es biventricular.
La comunicación interauricular es la única salida de la aurícula derecha lo que permite el tránsito obligado de sangre venosa sistémica hacia la aurícula izquierda. El ventrículo derecho no tiene entrada y por ello es incompleto e hipoplásico; de él emerge la arteria pulmonar en el 80% de los casos, o la aorta en “transposición” en un 20%.
https://www.cardiologopediatraenmonterrey.com/atresia-tricus...


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Note added at 8 hrs (2018-02-18 06:49:37 GMT)
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L-transposed anterior aorta
"However in a subset of patients, the aorta may be anterior and to the left of the pulmonary artery (levo-transposition of the great arteries)"
https://emedicine.medscape.com/article/900574-overview
It is definitely not a very common finding! ;)

Chema Nieto Castañón
Spain
Specializes in field
Native speaker of: Native in SpanishSpanish
PRO pts in category: 2
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