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Al Kindi H, Kandachar P, Mohsen A, Al Balushi A, Al Abri I, Maddali M, Anderson RH. Complex Atrial Baffling Procedures in Left Isomerism With Right- and Left-Hand Topology. World J Pediatr Congenit Heart Surg 2024; 15:530-533. [PMID: 38715424 DOI: 10.1177/21501351241247498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
We describe complex atrial baffling procedures in the setting of left isomerism with right-hand as opposed to left-handed ventricular topology. An appropriate understanding of the connections of the systemic and pulmonary veins, along with the internal atrial anatomy, as revealed using 3D printing, allowed for successful biventricular repair.
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Affiliation(s)
- Hamood Al Kindi
- Division of Cardiothoracic Surgery, Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
- The National Heart Center, The Royal Hospital, Seeb, Oman
| | | | | | | | - Ismail Al Abri
- The National Heart Center, The Royal Hospital, Seeb, Oman
| | - Madan Maddali
- The National Heart Center, The Royal Hospital, Seeb, Oman
| | - Robert H Anderson
- Biosciences Institute, Newcastle University, Newcastle Upon-Tyne, UK
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2
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Vidiyala P, Pandey NN, Gupta SK, Sreelal TV, Verma M, Kumar S, Ramakrishnan S, Jagia P. Identification and Analysis of Atrial-Bronchial-Abdominal Disharmony in Patients with Isomeric Atrial Appendages. Pediatr Cardiol 2024:10.1007/s00246-024-03544-3. [PMID: 38888643 DOI: 10.1007/s00246-024-03544-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 06/07/2024] [Indexed: 06/20/2024]
Abstract
Ideally, the morphology of atrial appendages should solely be used to identify and differentiate patients with isomeric right and left atrial appendages. However, in clinical practice, the segregation is often indirectly based on the arrangement of thoraco-abdominal structures. The correlation between thoraco-abdominal arrangement and atrial appendages, however, is imperfect. In this study, we sought to clarify the cardiovascular malformations in patients with isomeric atrial appendages with an emphasis on atrial-thoracic-abdominal disharmony. A retrospective review of all patients who underwent cardiac CT angiography between January 2014 and June 2023 and identified to have isomeric atrial appendages was performed. Of the 366 cases (median age: 2 years [interquartile range: 11 months-7 years]), 247 (67.5%) patients had isomeric right atrial appendages while 119 (32.5%) patients had isomeric left atrial appendages. In 316 (86.3%) patients, the thoraco-abdominal arrangement was as per atrial appendage morphology while the remaining 50 (13.6%) patients had disharmonious patterns. Compared to isomeric left atrial appendages, the disharmonious pattern was more frequent with isomeric right atrial appendages (5.9% vs. 17.4%; p 0.003). Irrespective of the type of isomerism, disharmony was mostly confined to the level of the abdomen. Not all patients with isomeric atrial appendages have a harmonious thoraco-abdominal arrangement. The atrial-bronchial-abdominal disharmony is more frequent with isomeric right atrial appendages and is mostly present at the level of the abdomen. A detailed sequential segmental analysis with an independent description of each organ system is, therefore, essential for the complete evaluation of patients with isomeric atrial appendages.
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Affiliation(s)
- Pujitha Vidiyala
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Niraj Nirmal Pandey
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Saurabh Kumar Gupta
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Thazhathu Veettil Sreelal
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Mansi Verma
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India
| | | | - Priya Jagia
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India
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Adhikari U, Gurajala V, Raja PD, Ayyappan A, Narasimhaiah D, Gopalakrishnan A. Asplenia in left isomerism. Ann Pediatr Cardiol 2024; 17:134-136. [PMID: 39184122 PMCID: PMC11343397 DOI: 10.4103/apc.apc_4_24] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/31/2024] [Accepted: 04/03/2024] [Indexed: 08/27/2024] Open
Abstract
Anatomical configurations where the viscero-atrial structures do not follow the usual arrangement or mirror-imaged arrangement is described conventionally as heterotaxy. Isomerism in the context of the congenitally malformed heart is a situation where some paired structures on opposite sides of the left-right axis of the body are, in morphologic terms, symmetrical mirror images of each other. It encompasses two separate entities, right and left isomerism, the former being usually associated with asplenia and the latter with polysplenia. We report herein a rare case of left isomerism that is associated with asplenia in a 4-year-old girl.
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Affiliation(s)
- Usnish Adhikari
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Venkatesh Gurajala
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Palanisamy Dinesh Raja
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Anoop Ayyappan
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Deepti Narasimhaiah
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Arun Gopalakrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Yoo SJ, Perens G, Nguyen KL, Yoshida T, Saprungruang A, Van Arsdell GS, Finn JP. Contemporary sequential segmental approach to congenital heart disease using four-dimensional magnetic resonance imaging with ferumoxytol: an illustrated editorial. Front Cardiovasc Med 2023; 10:1107399. [PMID: 37469486 PMCID: PMC10352920 DOI: 10.3389/fcvm.2023.1107399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 05/17/2023] [Indexed: 07/21/2023] Open
Abstract
The ferumoxytol-enhanced 4D MR angiography with MUSIC (Multiphase Steady State Imaging with Contrast) technique provides a single data set that captures dynamic cardiovascular anatomy and ventricular function at the same time. Homogeneous opacification of all cardiovascular structures within the imaging volume allows full sequential segmental approach to the congenital heart diseases without any blind spots. The complex systemic and pulmonary venous anatomy is particularly well captured in the MUSIC. Cinematographic display of multiplanar sectional and 3D volume images is helpful in the morphological identification of the cardiac chambers, the assessment of the dynamic nature of the ventricular outflow tracts, and the assessment of the coronary arterial origins and courses.
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Affiliation(s)
- Shi-Joon Yoo
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada
- Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Gregory Perens
- Department of Pediatric Cardiology, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Kim-Lien Nguyen
- Diagnostic Cardiovascular Imaging Section, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
- Division of Cardiology, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Takegawa Yoshida
- Diagnostic Cardiovascular Imaging Section, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Ankavipar Saprungruang
- Department of Pediatric Cardiology, Cardiac Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Glen S. Van Arsdell
- Department of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - J. Paul Finn
- Diagnostic Cardiovascular Imaging Section, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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Post-operative Morbidity and Mortality After Fontan Procedure in Patients with Heterotaxy and Other Situs Anomalies. Pediatr Cardiol 2022; 43:952-959. [PMID: 35064275 DOI: 10.1007/s00246-021-02804-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
Abstract
Heterotaxy is a complex, multisystem disorder associated with single ventricle heart disease and decreased survival. Ciliary dysfunction is common in heterotaxy and other situs abnormalities (H/SA) and may increase post-operative complications. We hypothesized that patients with H/SA have increased respiratory and renal morbidities and increased in-hospital mortality after Fontan procedure. We queried the Pediatric Health Information System database for hospitalizations with ICD-9/10 codes for Fontan procedure in patients aged 1 through 11 years from 2004 to 2019. H/SA was identified by codes for dextrocardia, situs inversus, asplenia/polysplenia, or atrial isomerism and compared to non-H/SA controls. Outcomes were in-hospital mortality or heart transplantation, ECMO, hemodialysis, length of stay (LOS), and mechanical ventilation or vasoactive medication use ≥ 4 days. We adjusted estimates with multivariable logistic regression. Of 7897 patients at 50 centers, 1366 (17%) met criteria for H/SA. H/SA had worse outcomes for all study measures: death/transplantation (1.9 vs 1.1%, OR 1.74 (95% CI 1.01-3.03); p = 0.047), ECMO (3.7 vs 2.3%, OR 1.74 (1.28-2.35); p < 0.001), hemodialysis (2.1 vs 1.2%, OR 1.66 (1.06-2.59); p = 0.026), prolonged mechanical ventilation (13.2% vs 7.6%, OR 1.85 (1.53-2.25); p < 0.001) and vasoactive medication use (29.4 vs 19.7%, OR 1.65 (1.43-1.90), and longer LOS (11 (8-17) vs 9 (7-14) days; p < 0.001). H/SA is associated with increased cardiovascular, renal, and respiratory morbidity, as well as in-hospital mortality after Fontan procedure. Attention to renal and respiratory needs may improve outcomes in this difficult population. The relationship between ciliary dysfunction and lung and renal morbidity should be explored further.
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Spicer DE, Chowdhury UK, Anderson RH, Pandey NN, Sankhyan LK, George N, Goja S, Malik V. The surgical anatomy of hearts with isomeric atrial appendages-implications for surgical management. Eur J Cardiothorac Surg 2022; 62:6540686. [PMID: 35234855 DOI: 10.1093/ejcts/ezac139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The most severe combinations of cardiac malformations exist in individuals having jumbled-up thoracic and abdominal organs. These patients make up 2 distinct syndromes. As yet, the consensus is lacking on how best to describe the subsets. The subsets are frequently grouped together in terms of 'heterotaxy'. The surgical approaches to the subsets, however, are markedly different. We reviewed our experiences with regard to the anatomy as observed in the autopsy room, by the analysis of computed tomographic studies, and in the operating room, to assess whether the lesions might be segregated on the basis of isomerism of the atrial appendages. METHODS AND RESULTS A review of our findings from the examination of specimens from several archives, along with investigation of a large cohort of patients being prepared for surgical treatment, showed that individuals can uniformly be segregated into subgroups on the basis of isomeric arrangement of the atrial appendages. In all instances, this was made possible by using the criterion of the extent of the pectinate muscles within the appendages as judged relative to the atrial vestibules. Segregation on this basis, which correlated excellently with the bronchial arrangement, sets the scene for an appropriate description of the remainder of the heart, providing the cardiac surgeon with all the inferences required for appropriate surgical intervention. CONCLUSIONS When assessing individuals having the features of so-called 'heterotaxy', it is possible to segregate the groups into subsets of individuals having either isomeric right or left atrial appendages. This approach provides the framework for the assessment of appropriate surgical management.
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Affiliation(s)
- Diane E Spicer
- Heart Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.,Department of Pediatric Cardiology, University of Florida, Gainesville, FL, USA
| | | | - Robert H Anderson
- Institute of Biomedical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Niraj Nirmal Pandey
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Lakshmi Kumari Sankhyan
- Department of Cardiothoracic Surgery, All India Institute of Medical Sciences, Bilaspur, India
| | - Niwin George
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Shikha Goja
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Vishwas Malik
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
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Chowdhury UK, Anderson RH, Spicer DE, Sankhyan LK, Pandey NN, Goja S, Rajasekar P, Arvind B, Pradeep D. Surgical management of hearts with isomeric atrial appendages. J Card Surg 2022; 37:1340-1352. [PMID: 35122446 DOI: 10.1111/jocs.16268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM On the basis of previously published accounts, coupled with our own experience, we have assessed the surgical approaches to patients with isomeric atrial appendages. METHODS We reviewed pertinent published studies on surgical treatment of individuals with isomeric atrial appendages, with the pertinent surgical details provided by most of the manuscripts. RESULTS Half of patients with right isomerism, and two-thirds of those with left isomerism have bilateral superior caval veins. Azygos extension of the inferior caval vein is reported in three-quarters of those with left isomerism. The coronary sinus is universally absent in right isomerism, along with totally anomalous pulmonary venous connection, and is absent in two-fifths of those with left isomerism. Univentricular atrioventricular connections are expected in up to three-quarters of those with right isomerism. Atrioventricular septal defect is reported in up to four-fifths, more frequently in right isomerism, with such patients typically having discordant ventriculoatrial connections or double outlet right ventricle. Reported mortalities extend to 85% for those with right, and 50% for those with left isomerism. In right isomerism, mortality is up to 54% for systemic-to-pulmonary arterial shunting, up to 75% for univentricular repair, and up to 95% for repair of totally anomalous pulmonary venous connection itself. No more than one-quarter had undergone Fontan completion, with reported mortalities of 21%. CONCLUSION Early surgical results are satisfactory in patients with left isomerism, but disappointing for those with right. Recent advances in cardiac and liver transplantation may offer improved survival.
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Affiliation(s)
- Ujjwal Kumar Chowdhury
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Robert H Anderson
- Institute of Biomedical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Diane E Spicer
- Heart Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.,Department of Pediatric Cardiology, University of Florida, Gainesville, Florida, USA
| | - Lakshmi K Sankhyan
- Department of Cardiothoracic Surgery, All India Institute of Medical Sciences, Bilaspur, India
| | - Niraj N Pandey
- Department of Cardiac Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shikha Goja
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Palleti Rajasekar
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Balaji Arvind
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Doniparthi Pradeep
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
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Heterotaxy - Res ipsos loquitur. Cardiol Young 2021; 31:1712-1714. [PMID: 34544512 DOI: 10.1017/s1047951121003814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The essence of so-called heterotaxy is the potential disharmony between the arrangement of the bronchuses, abdominal organs, and the atrial appendages. Accurate description of the heart, however, can only be provided by specific description of these features, all of which are readily discernible in the clinical setting. We argue that, when accurate description of the atrial and visceral arrangement is provided, along with appropriate description of the intracardiac findings, no further accuracy is gained by suggesting that an individual heart is "heterotaxic".
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Wang X, Chen S, Tu P, Liu X, Zhang X, Han J, Dong H, Ran S, He Y. Fetal Ultrasonic Evaluation of Bronchial Morphology in Fetuses with Isomerism. Fetal Diagn Ther 2021; 48:641-650. [PMID: 34510037 DOI: 10.1159/000515250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 02/15/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate whether fetal ultrasound could determine bronchial isomerism and distinguish left isomerism from right isomerism. METHODS We identified 110 healthy fetuses and 28 fetuses with isomerism. The outer angle between the tracheal midline and the inner margin of the bronchus is measured. The bronchial angles and the ratio of left/right bronchial angle were used to differentiate bronchial morphology and confirm the presence of bronchial isomerism in pathological cases. RESULTS The normal angles of the left and right bronchi were 146.98° (95% CI, 145.15-147.81°) and 167.37° (95% CI, 166.30-168.44°), separately. The cutoff bronchial angle of 156.5° was used to distinguish left bronchus from right bronchus. The bronchial isomerism could be identified in all pathological cases by autopsy and bronchial-atrial concordance occurred in 27 pathological cases (96.4%). In 21 pathological cases, the bilateral bronchial angle was <156.5 versus >156.5 differentiated left from right isomerism, respectively. The ratio of the left/right bronchial angle of >0.935 identified 92.9% (26/28) of all pathological cases, with a sensitivity of 89.7%. CONCLUSIONS Fetal ultrasound can detect the bronchial morphology and the presence of bronchial isomerism in fetuses with isomerism according to bronchial angles and the ratio of left/right bronchial angle.
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Affiliation(s)
- Xin Wang
- Maternal-Fetal Consultation Center of Congenital Heart Disease, Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Song Chen
- Department of Ultrasound Diagnosis, Chongqing Health Center for Women and Children, Chongqing, China
| | - Peng Tu
- Department of Ultrasound Diagnosis, Chongqing Health Center for Women and Children, Chongqing, China
| | - Xiaowei Liu
- Maternal-Fetal Consultation Center of Congenital Heart Disease, Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaohang Zhang
- Department of Ultrasound Diagnosis, Chongqing Health Center for Women and Children, Chongqing, China
| | - Jiancheng Han
- Maternal-Fetal Consultation Center of Congenital Heart Disease, Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hongmei Dong
- Department of Ultrasound Diagnosis, Chongqing Health Center for Women and Children, Chongqing, China
| | - Suzhen Ran
- Department of Ultrasound Diagnosis, Chongqing Health Center for Women and Children, Chongqing, China
| | - Yihua He
- Maternal-Fetal Consultation Center of Congenital Heart Disease, Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Hatipoglu S, Almogheer B, Mahon C, Houshmand G, Uygur B, Giblin GT, Krupickova S, Baksi AJ, Alpendurada F, Prasad SK, Babu-Narayan SV, Gatzoulis MA, Mohiaddin RH, Pennell DJ, Izgi C. Clinical Significance of Partial Anomalous Pulmonary Venous Connections (Isolated and Atrial Septal Defect Associated) Determined by Cardiovascular Magnetic Resonance. Circ Cardiovasc Imaging 2021; 14:e012371. [PMID: 34384233 DOI: 10.1161/circimaging.120.012371] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Partial anomalous venous connections (PAPVC) are associated with left to right shunting and right heart dilatation. Identification of PAPVC has increased with widespread use of cross-sectional imaging modalities. However, management strategies are mostly based on expert opinion given the scarcity of data from large series. We aimed to define types and significance of isolated and atrial septal defect (ASD) associated PAPVC detected by cardiovascular magnetic resonance. METHODS We retrospectively reviewed our cardiovascular magnetic resonance database from 2002 to 2018 to identify isolated or ASD-associated PAPVC cases. RESULTS A total of 215 patients (median age 46 years; range, 6-83) with isolated or ASD-associated PAPVC were identified among 102 135 clinical cardiovascular magnetic resonance studies. Of these, 104 were isolated and 111 were associated with an ASD. Anomalous connection of right upper pulmonary vein was the most common single venous anomaly (99/215), but in the isolated PAPVC group there were more anomalous left than right upper pulmonary veins (39 versus 34). The Qp/Qs was significantly higher for isolated anomalous single right upper pulmonary vein than left upper pulmonary vein (1.6 versus 1.4 respectively; P=0.01) as were right ventricular end-diastolic volumes (113.7±30.9 versus 90 [57-157] mL/m2, P=0.004). In the PAPVC with an ASD group, sinus venosus ASDs (82%) were associated with right-sided PAPVCs while both right and left-sided venous anomalies were seen in secundum ASDs (18%). In a substantial number of patients (30 out of 91) with sinus venosus ASDs, PAPVCs were more complex and involved more than a single anomalous right upper pulmonary vein; and in 5 patients with ASD, PAPVC was identified only after the ASD closure. CONCLUSIONS This large series provides descriptive and hemodynamic features for isolated and ASD-associated PAPVCs. Anomalous isolated right upper pulmonary vein may cause a significant shunt (Qp/Qs >1.5). PAPVC associated with sinus venosus and secundum ASDs might be more complex than a single anomalous pulmonary vein and missed before ASD correction.
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Affiliation(s)
- Suzan Hatipoglu
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
- Cardiovascular Magnetic Resonance Unit (S.H., B.A., C.M., G.H., G.T.G., S.K., S.V.B.-N., R.H.M., D.J.P., C.I.)
| | - Batool Almogheer
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
- Cardiovascular Magnetic Resonance Unit (S.H., B.A., C.M., G.H., G.T.G., S.K., S.V.B.-N., R.H.M., D.J.P., C.I.)
| | - Ciara Mahon
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
- Cardiovascular Magnetic Resonance Unit (S.H., B.A., C.M., G.H., G.T.G., S.K., S.V.B.-N., R.H.M., D.J.P., C.I.)
| | - Golnaz Houshmand
- Cardiovascular Magnetic Resonance Unit (S.H., B.A., C.M., G.H., G.T.G., S.K., S.V.B.-N., R.H.M., D.J.P., C.I.)
- Royal Brompton Hospital, London, United Kingdom; Now with Rajaie Cardiovascular Medical and Research Centre, Tehran, Iran (G.H.)
| | - Begum Uygur
- Cardiology Department, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Turkey (B.U.)
| | - Gerard T Giblin
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
- Cardiovascular Magnetic Resonance Unit (S.H., B.A., C.M., G.H., G.T.G., S.K., S.V.B.-N., R.H.M., D.J.P., C.I.)
| | - Sylvia Krupickova
- Cardiovascular Magnetic Resonance Unit (S.H., B.A., C.M., G.H., G.T.G., S.K., S.V.B.-N., R.H.M., D.J.P., C.I.)
- National Heart & Lung Institute, Imperial College, London, United Kingdom (S.K., A.J.B., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P.)
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom (S.K.)
| | - A John Baksi
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
- National Heart & Lung Institute, Imperial College, London, United Kingdom (S.K., A.J.B., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P.)
| | - Francisco Alpendurada
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
| | - Sanjay K Prasad
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
| | - Sonya V Babu-Narayan
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
- Cardiovascular Magnetic Resonance Unit (S.H., B.A., C.M., G.H., G.T.G., S.K., S.V.B.-N., R.H.M., D.J.P., C.I.)
- National Heart & Lung Institute, Imperial College, London, United Kingdom (S.K., A.J.B., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P.)
| | - Michael A Gatzoulis
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
- National Heart & Lung Institute, Imperial College, London, United Kingdom (S.K., A.J.B., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P.)
| | - Raad H Mohiaddin
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
- Cardiovascular Magnetic Resonance Unit (S.H., B.A., C.M., G.H., G.T.G., S.K., S.V.B.-N., R.H.M., D.J.P., C.I.)
- National Heart & Lung Institute, Imperial College, London, United Kingdom (S.K., A.J.B., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P.)
| | - Dudley J Pennell
- Cardiovascular Magnetic Resonance Unit (S.H., B.A., C.M., G.H., G.T.G., S.K., S.V.B.-N., R.H.M., D.J.P., C.I.)
- National Heart & Lung Institute, Imperial College, London, United Kingdom (S.K., A.J.B., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P.)
| | - Cemil Izgi
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
- Cardiovascular Magnetic Resonance Unit (S.H., B.A., C.M., G.H., G.T.G., S.K., S.V.B.-N., R.H.M., D.J.P., C.I.)
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Abnormal origin of the left pulmonary artery from the descending aorta and heterotaxy syndrome: an undescribed phenotypic association. Cardiol Young 2021; 31:1193-1196. [PMID: 34082847 DOI: 10.1017/s1047951121002183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Extensive screening in a newborn with prenatal suspicion of VACTERL syndrome identified an anomalous origin of the left pulmonary artery from the descending aorta with an arterial duct and left aortic arch, and normal intra-cardiac anatomy. Other anatomical anomalies suggested heterotaxy syndrome. At one-month-old, re-implantation of the 3.5 mm left pulmonary artery was performed by direct tension-low anastomosis. Post-operative course was complicated by severe left pulmonary atelectasis, and the patient died 20 days later.
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Abstract
Congenital heart disease is the most frequent birth defect and the leading cause of death for the fetus and in the first year of life. The wide phenotypic diversity of congenital heart defects requires expert diagnosis and sophisticated repair surgery. Although these defects have been described since the seventeenth century, it was only in 2005 that a consensus international nomenclature was adopted, followed by an international classification in 2017 to help provide better management of patients. Advances in genetic engineering, imaging, and omics analyses have uncovered mechanisms of heart formation and malformation in animal models, but approximately 80% of congenital heart defects have an unknown genetic origin. Here, we summarize current knowledge of congenital structural heart defects, intertwining clinical and fundamental research perspectives, with the aim to foster interdisciplinary collaborations at the cutting edge of each field. We also discuss remaining challenges in better understanding congenital heart defects and providing benefits to patients.
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Affiliation(s)
- Lucile Houyel
- Unité de Cardiologie Pédiatrique et Congénitale and Centre de Référence des Malformations Cardiaques Congénitales Complexes (M3C), Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France.,Université de Paris, 75015 Paris, France
| | - Sigolène M Meilhac
- Université de Paris, 75015 Paris, France.,Imagine-Institut Pasteur Unit of Heart Morphogenesis, INSERM UMR 1163, 75015 Paris, France;
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The multisystem nature of isomerism: left isomerism complicated by Abernethy malformation and portopulmonary hypertension. Cardiol Young 2021; 31:532-540. [PMID: 33731242 DOI: 10.1017/s1047951121000809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Isomerism, also referred to as "heterotaxy" is a complex set of anatomic and functional perturbations. One of the most obvious manifestations of isomerism is the disturbance of organ arrangement, such that the thoracic organs are no longer asymmetric on the left and right. We report the case of a 14-year-old female in whom exercise-induced dyspnea led to a late diagnosis of left isomerism complicated by Abernethy malformation and portopulmonary hypertension. A comprehensive evaluation revealed two anatomic left lungs and hyparterial bronchi, bilateral left atria, an interrupted inferior caval vein with azygos continuation, multiple spleens, sinus node dysfunction, hepatic hypertrophy with focal nodular hyperplasia, and absence of the portal vein. Pulmonary vasodilator therapy was initiated resulting in clinical improvement. This case exhibits unique features including a late diagnosis of isomerism with Abernethy malformation and portopulmonary hypertension. The patient's presentation, medical workup, and future treatment emphasise the importance of multidisciplinary care in children with complex multisystem disease. We review the multiple cardiac and extracardiac manifestations of isomerism.
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Congenitally Malformed Hearts: Aspects of Teaching and Research Involving Medical Students. J Cardiovasc Dev Dis 2021; 8:jcdd8040034. [PMID: 33800587 PMCID: PMC8065960 DOI: 10.3390/jcdd8040034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/22/2021] [Accepted: 03/25/2021] [Indexed: 11/17/2022] Open
Abstract
To appreciate congenital heart disease fully, a detailed understanding of the anatomical presentation, as well as the physiology, is required. This is often introduced at an advanced stage of training. Professor Anderson has been influential in the Clinical Anatomy Intercalated BSc programme at the University of Birmingham, in particular in his teaching on Sequential Segmental Analysis. This article describes the experiences of the latest cohort of students on this programme, who undertook varying research projects using the Birmingham Cardiac Archive, with the guidance of Professor Anderson. The projects outlined include various aspects of isomerism, encompassing both the cardiac and abdominal manifestations, as well as details of congenitally corrected transposition of the great arteries and prenatally diagnosed right aortic arch and double arch. These studies all aimed to increase the knowledge base of their respective cardiac malformations and provide a basis for further research.
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Transient Nodal Signaling in Left Precursors Coordinates Opposed Asymmetries Shaping the Heart Loop. Dev Cell 2020; 55:413-431.e6. [PMID: 33171097 DOI: 10.1016/j.devcel.2020.10.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 07/17/2020] [Accepted: 10/09/2020] [Indexed: 02/06/2023]
Abstract
The secreted factor Nodal, known as a major left determinant, is associated with severe heart defects. Yet, it has been unclear how it regulates asymmetric morphogenesis such as heart looping, which align cardiac chambers to establish the double blood circulation. Here, we report that Nodal is transiently active in precursors of the mouse heart tube poles, before looping. In conditional mutants, we show that Nodal is not required to initiate asymmetric morphogenesis. We provide evidence of a heart-specific random generator of asymmetry that is independent of Nodal. Using 3D quantifications and simulations, we demonstrate that Nodal functions as a bias of this mechanism: it is required to amplify and coordinate opposed left-right asymmetries at the heart tube poles, thus generating a robust helical shape. We identify downstream effectors of Nodal signaling, regulating asymmetries in cell proliferation, differentiation, and extracellular matrix composition. Our study uncovers how Nodal regulates asymmetric organogenesis.
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Abstract
Heterotaxy is a generalized term for patients who have an abnormality of laterality that cannot be described as situs inversus. Infants with heterotaxy can have significant anatomic and medical complexity and require personalized, specialized care, including comprehensive anatomic assessment. Common and rare anatomic findings are reviewed by system to help guide a thorough phenotypic evaluation. General care guidelines and considerations unique to this patient population are included. Future directions for this unique patient population, particularly in light of improved neonatal survival, are discussed.
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Affiliation(s)
- Gabrielle C Geddes
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA; Herma Heart Institute, Children's Hospital of Wisconsin, 9000 West Wisconsin Avenue, MS#716, Milwaukee, WI 53226, USA.
| | - Sai-Suma Samudrala
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael G Earing
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA; Herma Heart Institute, Children's Hospital of Wisconsin, 9000 West Wisconsin Avenue, MS#716, Milwaukee, WI 53226, USA; Section of Adult Cardiovascular Medicine, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Ugas Charcape CF, Alpaca Rodriguez LR, Matos Rojas IA, Lazarte Rantes CI, Valdez Quintana M, Katekaru Tokeshi DA, Epelman M. Characterisation of computed tomography angiography findings in paediatric patients with heterotaxy. Pediatr Radiol 2019; 49:1142-1151. [PMID: 31165901 DOI: 10.1007/s00247-019-04434-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/08/2019] [Accepted: 05/16/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Heterotaxy refers to the abnormal arrangement of organs across the left-right axis and is typically associated with complex cardiovascular malformations. OBJECTIVE To characterise the range of cardiac and extracardiac CT angiography findings in children with heterotaxy using the latest nomenclature consensus and to compare the different types of isomerism. MATERIALS AND METHODS We retrospectively analysed the data of 64 consecutive paediatric patients referred to our tertiary paediatric cardiovascular centre who underwent CT angiography for the evaluation of known or suspected heterotaxy within a 52-month period. RESULTS Right atrial isomerism was identified in 44 (69%) children, while left atrial isomerism was identified in 18 (28%) children. Atrial appendage anatomy and situs could not be determined in 2 children (3%). Associated heart defects included complete atrioventricular canal (CAVC) in 51 (80%) children, total anomalous pulmonary venous return in 43 (67%) and pulmonary atresia in 23 (36%). The bronchial branching pattern corresponded to atrial appendage morphology in all children except in the two in whom atrial appendage morphology could not be defined. In children with right atrial isomerism, the most common associated abnormalities were CAVC (n=41, 93%) and asplenia (n=34, 77%), while in those with left atrial isomerism, the most common associated abnormalities were polysplenia (n=17, 94%) and an interrupted inferior vena cava with azygos continuation (n=15, 83%). CONCLUSION CT angiography provides useful cardiovascular and extracardiac data on heterotaxy, which frequently involves a pattern of side-related findings but has great anatomical variability.
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Affiliation(s)
- Carlos F Ugas Charcape
- Department of Diagnostic Imaging, Instituto Nacional de Salud del Niño San Borja, Av. Javier Prado Este 3101, 15037, Lima, Peru.
| | - Larry R Alpaca Rodriguez
- Department of Diagnostic Imaging, Instituto Nacional de Salud del Niño San Borja, Av. Javier Prado Este 3101, 15037, Lima, Peru
| | - Irma A Matos Rojas
- Department of Diagnostic Imaging, Instituto Nacional de Salud del Niño San Borja, Av. Javier Prado Este 3101, 15037, Lima, Peru
| | - Claudia I Lazarte Rantes
- Department of Diagnostic Imaging, Instituto Nacional de Salud del Niño San Borja, Av. Javier Prado Este 3101, 15037, Lima, Peru
| | - Melissa Valdez Quintana
- Department of Diagnostic Imaging, Instituto Nacional de Salud del Niño San Borja, Av. Javier Prado Este 3101, 15037, Lima, Peru
| | - Doris A Katekaru Tokeshi
- Department of Diagnostic Imaging, Instituto Nacional de Salud del Niño San Borja, Av. Javier Prado Este 3101, 15037, Lima, Peru
| | - Monica Epelman
- Department of Medical Imaging/Radiology Nemours Children's Health System/Nemours Children's Hospital, University of Central Florida, College of Medicine, Orlando, FL, USA
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Yim D, Nagata H, Lam CZ, Grosse-Wortmann L, Seed M, Jaeggi E, Yoo SJ. Disharmonious Patterns of Heterotaxy and Isomerism: How Often Are the Classic Patterns Breached? Circ Cardiovasc Imaging 2019; 11:e006917. [PMID: 29444810 DOI: 10.1161/circimaging.117.006917] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 12/21/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND It is advocated that heterotaxy should be segregated into right or left isomerism according to atrial appendage morphology. However, atrial situs determination is often based on the pattern of associated findings rather than on atrial morphology itself, which can be difficult to define. The objective was to assess how often concordant patterns of isomerism classified by atrial appendage morphology, bronchopulmonary pattern, and splenic status are breached using cardiac magnetic resonance or computed tomography. The secondary objective was to determine the feasibility of defining atrial appendage morphology using cardiac magnetic resonance or computed tomography. METHODS AND RESULTS Retrospective review of 114 pediatric patients (median, 2.4 years; range, 1 day-17.9 years) with heterotaxy who underwent cardiac magnetic resonance or computed tomography was performed to evaluate atrial appendage, bronchopulmonary, and visceral organ arrangements. Atrial appendage and splenic anatomy were not definable in 17 of 114 (15%) and 4 of 114 (3.5%) patients, respectively. In the remaining 93 patients, 39% had classic right isomerism (bilateral right atrial appendages, right bronchopulmonary pattern, and asplenia) and 40% had classic left isomerism (bilateral left atrial appendages, left bronchopulmonary pattern, and polysplenia). Classic pattern of isomerism was breached in 20 of 93 (21.5%) patients: 13 (65%) displayed incongruent abdominal situs, 5 (25%) incongruent bronchial situs, 1 (5%) had discrepant appendage morphology, and 1 (5%) incongruent situs at all levels. CONCLUSIONS Atrial appendage morphology is difficult to assess and not always indicative of bronchopulmonary or abdominal situs. Discordance between bronchopulmonary branching, atrial appendage arrangement, and splenic status was identified in >20% patients with heterotaxy. Independent description of each organ system is required when arrangements are disharmonious among different organ systems.
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Affiliation(s)
- Deane Yim
- From the Labatt Family Heart Centre (D.Y., H.N., L.G.-W., M.S., E.J., S.-J.Y.) and Department of Diagnostic Imaging (C.Z.L., L.G.-W., M.S., S.-J.Y.), The Hospital for Sick Children, Toronto, Canada; and Department of Pediatrics, University of Toronto, Canada (L.G.-W., M.S., E.J., S.-J.Y.)
| | - Hazumu Nagata
- From the Labatt Family Heart Centre (D.Y., H.N., L.G.-W., M.S., E.J., S.-J.Y.) and Department of Diagnostic Imaging (C.Z.L., L.G.-W., M.S., S.-J.Y.), The Hospital for Sick Children, Toronto, Canada; and Department of Pediatrics, University of Toronto, Canada (L.G.-W., M.S., E.J., S.-J.Y.)
| | - Christopher Z Lam
- From the Labatt Family Heart Centre (D.Y., H.N., L.G.-W., M.S., E.J., S.-J.Y.) and Department of Diagnostic Imaging (C.Z.L., L.G.-W., M.S., S.-J.Y.), The Hospital for Sick Children, Toronto, Canada; and Department of Pediatrics, University of Toronto, Canada (L.G.-W., M.S., E.J., S.-J.Y.)
| | - Lars Grosse-Wortmann
- From the Labatt Family Heart Centre (D.Y., H.N., L.G.-W., M.S., E.J., S.-J.Y.) and Department of Diagnostic Imaging (C.Z.L., L.G.-W., M.S., S.-J.Y.), The Hospital for Sick Children, Toronto, Canada; and Department of Pediatrics, University of Toronto, Canada (L.G.-W., M.S., E.J., S.-J.Y.)
| | - Mike Seed
- From the Labatt Family Heart Centre (D.Y., H.N., L.G.-W., M.S., E.J., S.-J.Y.) and Department of Diagnostic Imaging (C.Z.L., L.G.-W., M.S., S.-J.Y.), The Hospital for Sick Children, Toronto, Canada; and Department of Pediatrics, University of Toronto, Canada (L.G.-W., M.S., E.J., S.-J.Y.)
| | - Edgar Jaeggi
- From the Labatt Family Heart Centre (D.Y., H.N., L.G.-W., M.S., E.J., S.-J.Y.) and Department of Diagnostic Imaging (C.Z.L., L.G.-W., M.S., S.-J.Y.), The Hospital for Sick Children, Toronto, Canada; and Department of Pediatrics, University of Toronto, Canada (L.G.-W., M.S., E.J., S.-J.Y.)
| | - Shi-Joon Yoo
- From the Labatt Family Heart Centre (D.Y., H.N., L.G.-W., M.S., E.J., S.-J.Y.) and Department of Diagnostic Imaging (C.Z.L., L.G.-W., M.S., S.-J.Y.), The Hospital for Sick Children, Toronto, Canada; and Department of Pediatrics, University of Toronto, Canada (L.G.-W., M.S., E.J., S.-J.Y.).
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Yoo SJ, Yim D, Nagata H, Lam CZ, Grosse-Wortmann L, Seed M, Jaeggi E. Response by Yoo et al to Letter Regarding Article, “Disharmonious Patterns of Heterotaxy and Isomerism: How Often Are the Classic Patterns Breached?”. Circ Cardiovasc Imaging 2018; 11:e007931. [DOI: 10.1161/circimaging.118.007931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Shi-Joon Yoo
- Labatt Family Heart Centre (S.-J.Y., D.Y., H.N., L.G.-W., M.S., E.J.)
- Department of Diagnostic Imaging (S.-J.Y., C.Z.L., L.G.-W., M.S.), The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Ontario, Canada (S.-J.Y., L.G.-W., M.S., E.J.)
| | - Deane Yim
- Labatt Family Heart Centre (S.-J.Y., D.Y., H.N., L.G.-W., M.S., E.J.)
| | - Hazumu Nagata
- Labatt Family Heart Centre (S.-J.Y., D.Y., H.N., L.G.-W., M.S., E.J.)
| | - Christopher Z. Lam
- Department of Diagnostic Imaging (S.-J.Y., C.Z.L., L.G.-W., M.S.), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lars Grosse-Wortmann
- Labatt Family Heart Centre (S.-J.Y., D.Y., H.N., L.G.-W., M.S., E.J.)
- Department of Diagnostic Imaging (S.-J.Y., C.Z.L., L.G.-W., M.S.), The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Ontario, Canada (S.-J.Y., L.G.-W., M.S., E.J.)
| | - Mike Seed
- Labatt Family Heart Centre (S.-J.Y., D.Y., H.N., L.G.-W., M.S., E.J.)
- Department of Diagnostic Imaging (S.-J.Y., C.Z.L., L.G.-W., M.S.), The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Ontario, Canada (S.-J.Y., L.G.-W., M.S., E.J.)
| | - Edgar Jaeggi
- Labatt Family Heart Centre (S.-J.Y., D.Y., H.N., L.G.-W., M.S., E.J.)
- Department of Pediatrics, University of Toronto, Ontario, Canada (S.-J.Y., L.G.-W., M.S., E.J.)
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Is an Appreciation of Isomerism the Key to Unlocking the Mysteries of the Cardiac Findings in Heterotaxy? J Cardiovasc Dev Dis 2018; 5:jcdd5010011. [PMID: 29415491 PMCID: PMC5872359 DOI: 10.3390/jcdd5010011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 01/29/2018] [Accepted: 02/05/2018] [Indexed: 02/06/2023] Open
Abstract
Pediatric cardiologists treating patients with severe congenital cardiac defects define “visceral heterotaxy” on the basis of isomerism of the atrial appendages. The isomeric features represent an obvious manifestation of disruption of left-right asymmetry during embryonic development. Thus, there are two subsets of individuals within the overall syndrome, with features of either right or left isomerism. Within the heart, it is only the atrial appendages that are truly isomeric. The remainder of the cardiac components shows variable morphology, as does the arrangement of the remaining body organs. Order is provided in this potentially chaotic arrangement simply by describing the specific features of each of the systems. These features as defined by clinicians, however, seem less well recognized by those investigating the developmental origins of the disruption of symmetry. Developmental biologists place much greater emphasis on ventricular looping. Although the direction of the loop can certainly be interpreted as representing an example of asymmetry, it is not comparable to the isomeric features that underscore the clinical syndromes. This is because, thus far, there is no evidence of ventricular isomerism, with the ventricles distinguished one from the other on the basis of their disparate anatomical features. In similar fashion, some consider transposition to represent abnormal lateralization, but again, clinical diagnosis depends on recognition of the lateralized features. In this review, therefore, we discuss the key questions that currently underscore the mismatch in the approaches to “lateralization” as taken by clinicians and developmental biologists.
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Loomba R, Anderson R. The role of cilia in the setting of isomerism and why isomerism is not a subset of heterotaxy. Int J Appl Basic Med Res 2018; 8:202. [PMID: 30123757 PMCID: PMC6082014 DOI: 10.4103/ijabmr.ijabmr_71_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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