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Background: Transposition of great arteries is a rare and very serious congenital heart defect. The discordant ventricular-arterial arrangement results in parallel circulation, depleting the body of oxygen rich blood. Objective: We report and comment on the imaging in the case of a baby boy with Ross IV heart failure due to transposition of great arteries, atrial and ventricular septal defect, aortic arch hypoplasia and aortic coarctation. Material and methods: A three months old baby was transferred to our hospital, previously being diagnosed with ventricular septal defect and complaining of functional respiratory syndrome, failure to thrive and low tolerance towards feeding. Upon admission the patient was cyanotic, with SaO2 of 60-65% under oxygen therapy. The imaging assessment (ultrasound and CT examination) diagnosed a right ventricle with double output, d-TGA without pulmonary protection, VSD wide outlet, bidirectional shunt, wide aortic coarctation, aortic arch hypoplasia, persistent arterial canal with bidirectional shunt and pulmonary hypertension. Results: Arterial switch surgery was performed at the same time with closing of the atrial and ventricular septal defect and the ligation of arterial canal. Three days later, surgical correction of aortic coarctation was performed. After proper treatment the patient's evolution was favorable. He was discharged with better respiratory function (SaO2 95%) and weight gain. Conclusion: The imaging assessment can reveal the spatial relationship between great arteries and diagnose all associated malformations for patients with d-TGA. Thus, knowing the congenital anatomy and developing an imaging focus for each patient, before surgical intervention, plays a crucial role. [ABSTRACT FROM AUTHOR]