 Good afternoon. Today I Dr. Shraddha Joshi, Ph.D. resident at the Department of Radio Diagnosis at Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ramanohaloya Hospital in New Delhi. I'm presenting an oral paper on the study of imaging findings of double outer triad ventricle and its associated malformations using DuvalSore CT. The co-authors of this paper are Dr. Munish Kularia Professor and Dr. Suryaansharora Senior Resident. Aim is to study the spectrum of imaging findings of double outer triad ventricle on DuvalSore CT and to study the various constant malformations associated with DuvalV. Introduction. Double outer triad ventricle is a complex consinital heart disease that occurs via ventricular arterial discordance. The aorta and the main pulmonary artery completely or predominantly arise from the right ventricle. Echocardiography is the first time imaging. However, it is limited by small acoustic window and operator dependence. ECG-gated DuvalSore CT provides high temporal resolution and excellent image quality with the advantage of flow-rode radiation dose. The choice of surgical correction or palliation depends on the relative position of the great arteries, the relationship between the great arteries and the VST and the presence of triad ventricular or protract obstruction. Classification of DuvalV. The first is a tetralogyophthalate type is the most common and characterized by subaortic VST with pulmonary stenosis. The second is a transposition of great arteries type or the TOSIC bling anomaly characterized by sub pulmonary VST without pulmonary stenosis. Third is the VST type characterized by subaortic VST without pulmonary stenosis. And the fourth is a unimentricular heart type characterized by DuvalV with mantral atresia unbalanced atrio ventricular canal or severe hypoplasia of one of the ventricular sinuses. Methodology. 20 children diagnosed with DuvalV after clinical examination and ecocardiography were evaluated with Siemens somatome definition flash 256 slice stable source CT. Intravenous non-ionic iodinated contrast dosage was calculated as a body weight and administered by a pressure injector. Scan delay was determined by manual bolostracking and CT angiography was done as a standardized protocol. Images were reconstructed with coronal sagittal and cardiac vascular planes as required and integrated. Results, the majority of the patients were in the age group of 0 to 3 months followed by the age group of 6 months to 1 year. 12 patients were male and 8 patients were female. The most common type of DuvalV in our study was the TOF type and 45% patients followed by the TGA type and 30% patients. The most common pattern of VST in our study was the subaortic type in 60% patients followed by sub pulmonary type in 25% and non-committed type in 15%. This is a CT image of TOF type of DuvalV. The first is a four chamber MPR image depicting hypertrophy of the right ventricle dilated right atrium and subaortic VST depicted by the star. The second image is oblique sagittal MPR image depicting right ventricular or protract with severe infundabular and valvular stenosis. This is our oblique coronal MPR image in the same patient depicting subaortic VST with more than 50% overriding of the EU term. Coming to the TGA type of DuvalV, the first image is an axial MIP image depicting the aortic and the pulmonary balls with the aortic ball present on the right of the pulmonary ball suggested DMGA. The second image is oblique MPR image depicting the right ventricular or protract with sub pulmonary VST depicted by the star. Coming to unipentricular heart type of DuvalV, the first image is an axial MPR image depicting a large atrium ventricular septal defect with both atria opening into the right ventricle and showing right atrium morphology. Ostium Secondum ASD is also present depicted by the solid arrow. The second image is oblique MPR image depicting the aorta and the main pulmonary artery is arising from the right ventricle with the MPF present posterior to the aorta. Coming to abnormalities of the cytus, cytus ambiguous was seen in four patients and cytus inverses in one patient. The first image is an axial CCT image depicting centrally paced liver and stomach bubble with absent pain suggestive cytus ambiguous and the second image is an axial CCT image depicting the liver on the left and the spleen on the right suggestive of cytus inverses. Coming to abnormalities in arrangement of great vessels, the most common pattern of abnormal arrangement of great vessels was DTGA in four patients followed by DMGA in three patients. L transposition of predatory was seen in one patient. The first image is an axial MPR image depicting the aortic valve present anterior to and right of the pulmonary valve with pulmonary varivillus gnosis suggestive of DTGA. The second image is an axial MPR image depicting the aortic and the pulmonary valve present side by side suggestive of DTGA. Coming to aortic arch abnormalities, the most common aortic arch abnormalities was in left-sided arch with four vessel pattern of branching followed by the right-sided arch with mirror branching in three patients. Other aortic arch abnormalities noted for the right-sided arch with four vessel branching in one patient, covacation of aorta, dilatation of aortic arch in ascending aorta and subvalvular aortic stenosis. Coming to coronary artery abnormalities, the most common type of abnormality seen in the patients was one LCX2R pattern followed by triple ostea in one patient and common origin of the LAD and the right obtuse marginal artery in one patient. Coming to abnormalities in systemic veins, the most common pattern of abnormality in our study was a double SVC in 30% patients. This is our bleak coronal mipimage depicting the double SVC with the right-sided superior vena kiva draining into the right-sided atrial chamber and the left-sided superior vena kiva draining into the left side of the chamber. Other abnormalities noted were the related systemic veins in four patients, the left-sided single SVC in one patient and abnormal hepatic venous drainage in one patient. Coming to abnormalities in pulmonary arteries and pulmonary bulge, the most common abnormality of the pulmonary arterial system was the impundibular stenosis in 65% patients, followed by valvular stenosis in 35% patients. Other pulmonary arterial abnormalities seen were the stenosis of the main pulmonary arteries, stenosis or hypokinesia of the branched pulmonary arteries, pulmonary arteriesia, pulmonary arterial thrombus or diverticulum. The first image is the oblique sagittal MPR image depicting the right perpendicular or protracted severe infundibular and valvular stenosis and the second image is the axiomipimage of a different patient depicting stenosis of the right pulmonary artery at its origin. Also seen in the second image are the bilateral superior vena kiva and few aotopulmonary collateral arising from the DTA. This is an axial MPR image depicting hypoplastic main and branched pulmonary arteries. The second image shows a hypodense filling effect in the left pulmonary artery suggestible thrombus. Coming to abnormalities of the pulmonary veins, the most common pulmonary venous abnormality was a supracardic pattern of TAPVC seen in three patients, followed by cardiac TAPVC in two patients. The first image is the oblique coronal mipimage depicting the right and the left pulmonary arteries forming a confluence and draining into superior vena kiva, suggestive of a supracardic pattern of TAPVC. Also seen in this image is the abnormal drainage of the hepatic veins wherein the left and the middle hepatic veins form a confluence and drain separately into the atrio chamber. The second image shows the confluence of the pulmonary veins behind the left atrio chamber and the drainage suggestive of a cardiac TAPVC. Discussion, DOAV is a complex continental heart disease with both great vessels arising completely or predominantly from the right ventricle. Surgical planning of DOAV is dependent on the location of VST, the relationship of great vessels to the VST and presence or absent of the right ventricle or protracted obstruction. This subtraction angiography is the gold standard imaging modality for evaluation of pediatric patients with DOAV. Ecocardiography and dual source CT are the common non-invasive modalities used for assessment of DOAV. In our study, the most common type of DOAV was a TOF type followed by the TGA type. These results are similar to the studies conducted by Priya et al. The most common location of VST was a subbiotic type. This is similar to the study conducted by Sri et al. In our study, the most commonly associated normally with DOAV was pulmonary infundabulous noses followed by valvular stenosis. Our study was limited by the limited sample size and selection bias. Conclusion, the most common type of DOAV is the TOF type, the most common pattern of VST is a subbiotic type and the most commonly associated abnormality with DOAV is the pulmonary infundabulous noses. Other abnormalities associated with DOAV are pulmonary valvular stenosis, double-sided SVC, atrial ventricular septal defect and right isomerism. We conclude that dual-zone CT has good diagnostic accuracy in the preoperative assessment of DOAV and associated cardiac malformations in pediatric patients. These are my references.