Thoracoatrial discordance in a case of twisted atrioventricular connections: A unique configuration of visceroatrial arrangement.

We present a case of a 12-year-old boy with discordance between the atrial arrangement and the thoracoabdominal arrangement in the setting of twisted atrioventricular connections. This case highlights the importance of a separate description of all visceral organs and venous drainage for an accurate description of visceroatrial arrangement in cases of congenital heart defects.

Ruptured Sinus of Valsalva Aneurysm Associated with Situs Ambiguus, Isolated Levocardia, and Polysplenia.

Aneurysm of the sinus of Valsalva, a rare cardiac condition, results from dilation of an aortic sinus. Sudden aneurysm rupture can trigger rapidly progressive heart failure. We discuss the case of a 57-year-old woman with situs ambiguus, isolated levocardia, and polysplenia who presented with acute-onset heart failure. Transesophageal echocardiograms revealed an aneurysm of the right coronary sinus of Valsalva that had ruptured into the right atrial cavity. The patient underwent successful surgical repair. To our knowledge, this is the first report of a sinus of Valsalva aneurysm in a patient with this combination of congenital abnormalities. We briefly review the association between congenital heart disease, situs ambiguus, and ciliary dysfunction.

Clinics in diagnostic imaging (160). Levocardia with abdominal situs inversus.

Levocardia (left-sided cardiac apex) with abdominal situs inversus is extremely rare. This is also known as isolated levocardia and is almost always associated with severe forms of congenital heart defects with poor prognosis. We report isolated levocardia in a 13-year-old symptomatic male patient. The purpose of this paper is to outline the imaging features of isolated levocardia and to highlight the role of cardiovascular magnetic resonance imaging (CMR) in the diagnosis and management of such cases. Other forms of cardiac malposition, including dextrocardia, mesocardia and criss-cross heart, with chest radiograph and CMR correlation, are also discussed.

Anatomically corrected malposition of the great arteries: two case reports.

Anatomically corrected malposition of the great arteries (ACMGA) is defined as parallel arising of aorta and main pulmonary artery (PA) roots although ventriculoarterial connection is normal. Abnormally related aorta arises from the left ventricle, while abnormally related PA arises from the right ventricle. It can be diagnosed with via echocardiography. In some cases, additional imaging modalities such as computerized tomographic angiography and magnetic resonance are required. In this article, we presented two cases of ACMGA, 5-month-old boy and 1-month-old girl. We wanted to point out the importance of differential diagnosis of other great artery anomalies from this rare pathology.

Progressive fetal atrioventricular block in heterotaxy syndrome.

We report a fetus with left isomerism, in whom the atrioventricular block progressed from low grade second degree to complete block and fetal hydrops. While it is known that there is a high incidence of heart block in the fetus with left isomerism, as far as we are aware, ours is the first report of Wenckebach type block documented in the fetus by Doppler echocardiography, and demonstration of the progression of heart block during fetus life in the setting of left isomerism.

Splenic abscess in a boy with isolated levocardia.

Levocardia with situs inversus is a rare condition. We present the case of a fourteen-year-old boy with congenital cyanotic heart disease, isolated levocardia and splenic abscess. It is the first report of both these conditions occurring in the same person.

[Ventricular-infundibular morphology in visceral heterotaxia with left isomerism. An echocardiographic-angiocardiographic study]. / Morfologia ventricolo-infundibolare nell'eterotassia viscerale con isomerismo sinistro. Studio eco-angiocardiografico.

We report 2D-echocardiographic and angiocardiographic assessment of 28 cases of visceral heterotaxia with left atrial isomerism, with particular emphasis on infundibular ventricular morphology. Ventricular D-loop was present in 15 cases (52.6%), and ventricular L-loop in 13 (46.4%); 25/48 patients had concordant ventricular loop and cardiac position (89.3%). In 18 patients (64.3%) there were 2 balanced ventricles; of the other 10 patients, 9 (32.1%) presented right and 1 (3.6%) left ventricular dominance. Ventricular septal defect was present in 12 cases (42.8%). Ventriculo-arterial connections were concordant, with "normally related" great arteries in 9/15 cases with ventricular D-loop (60%). In these cases, ventricular morphology, connections and relations of the great arteries were typical of situs solitus. In the remaining 6 patients there was double-outlet right ventricle, also with normally related great arteries. In 12/13 cases (92.3%) with ventricular L-loop ventriculo-arterial connections were concordant with "mirror image normally related" great arteries. In these cases, ventricular morphology, connections and relations of the great arteries were typical of situs inversus. In one patient there was double-outlet right ventricle, also with mirror image normally related great arteries. Twelve patients (42.8%) had pulmonary stenosis and 5 had a systemic outflow obstruction (17.8%). From these observations we conclude that ventriculo-infundibular morphology, either of situs solitus-type or of situs inversus-type, is a typical anatomical feature of left atrial isomerism. These results may have important implications in the diagnosis and in the surgical management of patients with left atrial isomerism.

Prolonged survival with isolated levocardia and situs inversus.

Isolated levocardia with situs inversus, or ILSI, is a rare anomaly with a reported incidence of 1:22,000 in the general population and from 0.4% to 1.2% of all patients with congenital heart diseases. It is commonly associated with both congenital heart disease and splenic abnormalities, either asplenia or polysplenia. The prognosis is poor, and only about 5% to 13% of patients survive more than 5 years. The case described here, which had computed tomographic findings, is the first case reported with multiple malignancies associated with ILSI. This patient, at 73 years of age, is the second longest survivor reported in the literature.

[Isolated ventricular inversion associated with complete atrioventricular septal defect with total anomalous pulmonary venous drainage]. / Inversión ventricular aislada asociada a defecto completo del septo atrioventricular con drenaje venoso pulmonar anómalo total.

Based upon the description of the clinico-pathological characteristic of a case with isolated ventricular inversion plus other cardiac malformations, the clinical, diagnostic and embryo-pathological implications of this entity are reviewed.

Mirror image arrangement of the abdominal organs with a left-sided morphologically normal heart.

A twenty year old man is described who has a left-sided liver, a single right-sided spleen, an anomalous inferior vena cava with azygos continuation, and a morphologically normal left-sided heart. These findings emphasise the pitfalls in predicting cardiac abnormalities from other aberrations of anatomical situs.

Ventricular septal defect and subaortic stenosis: an analysis of 41 patients.

Forty-one patients with subaortic stenosis (SAS) and ventricular septal defect (VSD) were identified from the cardiac records of the Hospital for Sick Children, Toronto, Ontario. The diagnosis of an associated SAS was made clinically in only 1 patient, who had findings of left ventricular (LV) hypertrophy with strain on the electrocardiogram. There was a delay of 3.1 years between initial presentation and detection of SAS. The SAS was not diagnosed at initial catheterization in 17 patients and was confirmed at subsequent catheter studies in 8 patients, surgery in 5 and autopsy in 4. Associated defects included coarctation of the aorta in 12 patients, mitral valve abnormalities in 4, and right-sided obstructions, including anomalous right ventricular muscle bundles in 6 patients, tetralogy in 4 and pulmonic stenosis in 1 patient. The mean gradient across the LV outflow tract was 25 mm Hg. Nineteen patients had serial catheters without intervening surgery, and the outflow gradient increased from a mean of 9 to 36 mm Hg. The mechanism of SAS consisted of fibrous diaphragm and fibromuscular obstruction in 31 cases, muscular narrowing in 4, protruding tricuspid valve leaflet in 2, hypertrophic cardiomyopathy in 2, anterolateral twist in 1 patient and redundant tissue tag in 1. Thirty-eight patients had a perimembranous VSD, 19 of whom had an associated so-called aneurysm of the membranous septum; 2 had an infundibular VSD and 1 patient had a central muscular defect. Although the SAS was located below the VSD in 30 cases, the associated heart failure and reduced cardiac output can mask the presence or severity of associated SAS.(ABSTRACT TRUNCATED AT 250 WORDS)