Taussig Bing anomaly was initially described in 1949 in a 5.5-year-old girl who died after injection of contrast during angiocardiography. An autopsy revealed a peculiar structural abnormality of the heart- both the aorta and the pulmonary artery originated from the right ventricle. At the same time, a subpulmonic ventricular septal defect (VSD) was observed and the right ventricle was hypertrophic [1] [2].

Hemodynamic changes seen in the Taussig Bing anomaly include:
- blood flow from the left ventricle (LV) through the VSD to the pulmonary artery preferentially
- blood flow from the right ventricle (RV) through the aorta preferentially

Another important characteristic of this disease is the absence of continuity of the mitral and semilunar valves [3] [4] [5]. This feature differentiates this condition from transposition with VSD and an overriding pulmonary artery.

As a consequence of this malformation, very small quantities of oxygenated blood enter the systemic circulation. This results in low oxygen saturation and cyanosis, which may be present at birth. Dyspnea at rest and developmental delay are the other typical features seen. Compensatory erythrocytosis may also be observed.

Death in the first described patient of the Taussig Bing anomaly, occurring after rapid injection of contrast material in the superior vena cava, was due to the elevation in pressure of the right side of the heart. This decreased the left-to-right shunt, leading to extremely low volumes of oxygenated blood being pumped towards the systemic circulation [6].

• Cyanotic Congenital Heart Disease

  Allopurinol and benzbromarone together were partially effective treatments for hyperuricemia in this patient with cyanotic congenital heart disease. [ncbi.nlm.nih.gov]

  Surgery indicated for relief of cyanotic congenital heart disease and PGE-1-dependent systemic blood flow. The procedure was as follows: ventricular septal defect baffle closure, ascending aorta and arch reconstruction, and arterial switch operation. [ctsnet.figshare.com]

  Bing) is a cyanotic congenital heart disease characterized by the dual presence of a subpulmonic ventricular septal defect (VSD) along with a double outlet right ventricle (DORV). [symptoma.com]

• Dyspnea

  Dyspnea at rest and developmental delay are the other typical features seen. Compensatory erythrocytosis may also be observed. [symptoma.com]

  A 23-year-old primigravida at term, presented with grade III dyspnea (New York Heart Association grading). [aeronline.org]

  He loves music and has composed more than 250 musical pieces.11 Description of Taussig-Bing Anomaly In 1949, Taussig and Bing described the case of a 5.5-year-old girl who had cyanosis since birth, developmental delay, systolic murmur, and dyspnea at [ncbi.nlm.nih.gov]

• Tachypnea

  Case report Nine month male baby was admitted with fever and tachypnea. She was product of non-consanguineous marriage and was delivered normally. She weighed 3.9 kg while at birth 2.2 kg. [journals.viamedica.pl]

• Heart Disease

  Allopurinol and benzbromarone together were partially effective treatments for hyperuricemia in this patient with cyanotic congenital heart disease. [ncbi.nlm.nih.gov]

  Diagnosis and Management of Adult Congenital Heart Disease, by Drs. Gatzoulis, Webb, and Daubeney, is a practical, one-stop resource designed to help you manage the unique challenges of treating long-term adult survivors of congenital heart disease. [books.google.com]

  Females with this complex heart disease, when pregnant, have to undergo significant cardiovascular challenges during pregnancy and delivery. [aeronline.org]

  Surgery indicated for relief of cyanotic congenital heart disease and PGE-1-dependent systemic blood flow. The procedure was as follows: ventricular septal defect baffle closure, ascending aorta and arch reconstruction, and arterial switch operation. [ctsnet.figshare.com]

• Cyanosis

  We report a 6 years old male child, presented with difficulty in swallowing, crying and smiling from early infancy and recurrent episodes of cyanosis on exertion for about 2 years. [ncbi.nlm.nih.gov]

  In Taussig-Bing anomaly, as the flow is from RV to aorta and LV blood preferentially enters the lung, cyanosis dates since birth. Consequently, neonates typically present with cyanosis, systolic murmur and heart failure. [journals.viamedica.pl]

  There was grade II clubbing and cyanosis. Her room air SpO 2 was 80–85% and increased to 92% with oxygen supplementation. There was no pedal edema. [aeronline.org]

• Heart Murmur

  On initial physical examination, the animal was bright and alert and major findings were limited to a loud systolic heart murmur radiating widely over both sides of the thorax. [readbyqxmd.com]

  Symptoms may include: A heart murmur (an extra, unusual heart sound) Breathing problems, including difficulty breathing, shortness of breath, or rapid breathing Difficulty eating and/or gaining weight Blueness of the lips, nails, and/or skin (cyanosis [my.clevelandclinic.org]

  […] heart defect corrective surgeries Congenital heart disease Coronary artery fistula Cyanotic heart disease Dextrocardia Double aortic arch Double inlet left ventricle Ebstein's anomaly Eisenmenger syndrome Electrocardiogram Endocardial cushion defect Heart [icdlist.com]

• Systolic Murmur

  Consequently, neonates typically present with cyanosis, systolic murmur and heart failure. As the pulmonary vascular resistance increases, PBF curtails and cyanosis deepens but longevity prolongs. [journals.viamedica.pl]

  Other features include underdevelopment, cardiomegaly, systolic murmur in left third intercostal space, loud second pulmonic sound. If survival continues for a few years, polycythaemia and clubbing of fingers and toes become evident. [whonamedit.com]

  He loves music and has composed more than 250 musical pieces.11 Description of Taussig-Bing Anomaly In 1949, Taussig and Bing described the case of a 5.5-year-old girl who had cyanosis since birth, developmental delay, systolic murmur, and dyspnea at [ncbi.nlm.nih.gov]

• Palpitations

  Patient had a history of palpitations not associated with chest pain or any syncopal attack. At 15 years of age patient had breathlessness for which she was prescribed tablet furosemide 40 mg overdose (OD) by her primary care physician. [aeronline.org]

Echocardiography is the most common method used for the diagnosis of Taussig Bing anomaly. The primary four criteria that support the diagnosis include:

• Both pulmonary artery and aorta emerge from the right ventricle
• Blood from the left ventricle flows only through the ventricular septal defect
• The aorta is situated to the right or anteriorly to the pulmonary artery
• The absence of pulmonary–mitral continuity [7] [8].

This congenital heart anomaly can also be diagnosed prenatally via real-time 2-dimensional echocardiography. Real-time 3-dimensional echocardiography offers no special benefits over the 2-dimensional mode [9].

A chest X-ray in these patients may show non-specific changes that include cardiomegaly, increased pulmonary vascular markings and a prominent pulmonary artery (PA) segment. However, normal cardiac anatomy may be observed in patients who have pulmonary stenosis in addition to the primary defects.

Other imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI), especially 3-dimensional MRI, can be used for the precise evaluation of the cardiac and blood vessel anatomy.

Physical examination may reveal findings suggestive of a large septal defect, such as a holosystolic murmur and a thrill at the base of the heart. No pathological blood pressure gradients between the upper and lower limbs have been observed [10].

Resting electrocardiogram (ECG) may show a right axis deviation, hypertrophy of the right ventricle, intraventricular conduction defects and negative T waves in leads I, avL and V5-V6. Holter monitoring may show evidence of arrhythmias such as a wide complex tachycardia and ventricular/ supraventricular premature beats. Stress testing may reveal a reduction in exercise capacity and a decreased consumption of maximal oxygen.

• Pneumoperitoneum

  Six months after an uncomplicated neonatal ASO with aortic arch reconstruction, the patient succumbed to severe pneumonia complicated by sepsis, pneumothoraces, and pneumoperitoneum. [ahajournals.org]

• Right Axis Deviation

  Resting electrocardiogram (ECG) may show a right axis deviation, hypertrophy of the right ventricle, intraventricular conduction defects and negative T waves in leads I, avL and V5-V6. [symptoma.com]

  Electrocardiogram showed right axis deviation, clockwise loop, right ventricular hypertrophy and well preserved R waves in V5–V6 reflecting LV volume overload. Echocardiogram The visceroatrial situs was solitus with levocardia (Fig. 1A). [journals.viamedica.pl]

  Resting ECG showed right axis deviation, low atrial rhythm with a heart rate of 79 beats/minute, intraventricular conduction disturbances, right ventricular hypertrophy, negative T waves in I, avL, V5-V6. [crcd.eu]

  Electrocardiogram • NSR • PR Prolongation • Atrial electrical abnormality • Counter clock loop • Clockwise QRS • RVH • Right axis deviation 20. Clinical classification • The More Common Types • A. [slideshare.net]

  The electrocardiogram is notable for right axis deviation and a right ventricular hypertrophy pattern, with rR′, qR, or rsR′ pattern; these findings are not, however, sufficiently specific to be diagnostic. [thoracickey.com]

• Right Ventricular Hypertrophy

  Electrocardiography findings were sinus rhythm with first degree heart block, right bundle branch block and right ventricular hypertrophy. [aeronline.org]

  Cardiomegaly and right ventricular hypertrophy are usually present. Permanent and progressive cyanosis usually begins at birth. [whonamedit.com]

  Electrocardiogram showed right axis deviation, clockwise loop, right ventricular hypertrophy and well preserved R waves in V5–V6 reflecting LV volume overload. Echocardiogram The visceroatrial situs was solitus with levocardia (Fig. 1A). [journals.viamedica.pl]

  Preoperatively, echocardiography of the patient was suggestive of double-outlet right ventricle (DORV) with large sub-pulmonic ventricular septal defect (VSD), right ventricular hypertrophy, bidirectional shunt and severe pulmonary artery hypertension [readbyqxmd.com]

  Her electrocardiogram showed sinus rhythm, high P waves in the second lead, and signs of right ventricular hypertrophy. [ncbi.nlm.nih.gov]

1. Taussig H, Bing R. Complete transposition of the aorta and a levoposition of the pulmonary artery. Am Heart J. 1949;37:551-9.
2. Stellin G, Zuberbuhler J, Anderson R, Siewers R. The surgical anatomy of the Taussig—Bing malformation. J Thorac Cardiovasc Surg. 1987;93:560-9.
3. Roger H. Clinical researches on the congenital communication of the two sides of the heart by failure of occlusion of the interventricular septum. Bull de l' Acad de Med. 1879;8:1074.
4. Wood P. The Eisenmenger syndrome or pulmonary hypertension with reversed central shunt. Br Med J. Sep 1958;2(5099):755-62.
5. Heath D, Edwards J. The pathology of hypertensive pulmonary vascular disease; a description of six grades of structural changes in the pulmonary arteries with special reference to congenital cardiac septal defects. Circulation. Oct 1958 ;4.
6. Van Praagh R. What is the Taussig-Bing malformation? Circulation. 1968;38(3):445-9.
7. Comas J, Mignosa C, Cochrane A, Wilkinson J, Karl T. Taussig—Bing anomaly and arterial switch operation: aortic arch obstruction does not influence outcome. Eur J Cardiothorac Surg. 1996;10:1114-9.
8. Parr G, Waldhausen J, Bharati S, Lev M, Fripp R, Whitman V. Coarctation in Taussig—Bing malformation of the heart. Surgical significance. J Thorac Cardiovasc Surg. 1983;86:280-7.
9. Rodefeld M, Ruzmetov M, Vijay P, Fiore A, Turrentine M, Brown J. Surgical results of arterial switch operation for Taussig-Bing anomaly: is position of the great arteries a risk factor? Ann Thorac Surg. Apr 2207;83(4):1451-7.
10. Yacoub M, Radley-Smith R. Anatomic correction of the Taussig—Bing anomaly. J Thorac Cardiovasc Surg. 1984;88:380-8.