Two dimensional echocardiographic diagnosis of situs.

Abstract

SUMMARY At present there is no reliable method of recognising atrial isomerism by two dimensional echocardiography. We therefore used two dimensional echocardiography to examine 158 patients including 25 with atrial isomerism and four with situs inversus. Particular attention was paid to the short and long axis subcostal scans of the abdomen.Using the position of the inferior vena cava and the aorta with respect to the spine it was possible to separate those with situs solitus from the others. Two false positives for abnormal situs had exomphalos. In situs solitus the aorta lay to the left of the spine and the inferior vena cava lay to the right. One patient with situs solimus and azygos continuation of the inferior vena cava also had inferior vena cava to right atrial connection. In the four patients with situs inversus the mirror image of the normal pattern was present.In nine patients with right isomerism the inferior vena cava and aorta ran together on one or other side of the spine. The inferior vena cava, anterior to the aorta at the level of the diaphragm, received at least the right hepatic veins (normal or partial anomalous hepatic venous connection).Of the 16 patients with left isomerism, 14 had azygos continuation of the inferior vena cava which was visualised posterior to the aorta in all but two. All patients with left isomerism had total anomalous hepatic venous connection to one or both atria via one or two separate veins.Two dimensional echocardiography therefore provides the means of detecting abnormal atrial situs and of diagnosing right or left isomerism in the great majority of patients, if not all.Accurate determination of atrial situs is the foundation of a segmental approach to the diagnosis of congenital malformations and malpositions. 1 Many clinical clues are available for the recognition of patients with abnormal situs, and the importance of identifying left and right isomerism has been emphasised by many authors.5-8 A non-invasive examination such as two dimensional echocardiography which could be used routineWo determine situs would be very useful. At present, the determination ofatrioventricular connection by two dimensional echocardiography is speculative and other techniques are necessary to assign atrial situs.8-10 Alerted to the presence of abnormal situs, the echocardiographer will pay particular attention to the systemic and pulmonary venous connections.To investigate the diagnosis of situs by two dimensional echocardiography we examined 158 consecutive patients including 11 who were known to have

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“…La visualización de la VCI en la sección transversa del abdomen fetal es la forma más simple y efectiva de sospechar anomalías de esta porción del sistema venoso (23). No sólo importa si está presente o ausente, sino que además su posición Figura 6.…”

Contribuição para o diagnóstico e o tratamento das fístulas arteriovenosas pulmonares após a operação de Glenn bidirecional

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Efficacy of MRI in Complicated Congenital Heart Disease with Visceral Heterotaxy Syndrome

“…An examination of the pectinate muscle is the best guide to atrial arrangement (10), but the resolution capacity of MRI is still limited in terms of recognizing the arrangement of these muscles. The situs can be determined by other methods, such as 1) the bronchial structure (11), 2) the positional relation of the PA to the bronchi (1,2), 3) lung lobulation, 4) splenic status, and 5) the position of the IVC and aorta (12). MRI not only delineates the atrial appendage but can also delineate these features without additional effort.…”