Aims:Evidence is emerging that,in the setting of isomerism,the atrial and bronchial arrangement are not always concordant,nor are these patterns always harmonious with the arrangement of the abdominal organs.We aimed ...Aims:Evidence is emerging that,in the setting of isomerism,the atrial and bronchial arrangement are not always concordant,nor are these patterns always harmonious with the arrangement of the abdominal organs.We aimed to evaluate the concordance between these features in a cohort of patients with cardiac malformations in the setting of known isomerism,seeking to determine whether it was feasible to assess complexity on this basis,in this regard taking note of the potential value of bronchial as opposed to appendage morphology.Methods and Results:We studied 78 patients known to have isomerism of the bronchuses,43 with right and 35 with left isomerism.Appendage anatomy could be determined in 49 cases(63%),all but one of these being concordant with bronchial anatomy.When assessing abdominal features,in only 59 cases(76%)was splenic morphology in keeping with the thoracic findings.As expected,right isomerism was associated with greater complexity of cardiac malformations,with an odds ratio of 6.53,with confidence intervals from 2.2–19.3(p<0.001).The odds were slightly decreased with thoraco-abdominal disharmony,when lesions shown to carry higher risk were then found in the setting of left isomerism.Conclusion:Harmony is excellent between bronchial and appendage isomerism,but less so with the arrangement of the abdominal organs.Right isomerism in our cohort,was indicative of a sixfold increase in intracardiac complexity.When discordance was found between the systems,however,the cardiac anomalies were less typical of the anticipated findings for right vs.left isomerism of the appendages.展开更多
In the last issue,two case reports separately present examples of the extremely rare and complex congenital heart diseases that show concordant atrioventricular connections to the L-looped ventricles in the presence o...In the last issue,two case reports separately present examples of the extremely rare and complex congenital heart diseases that show concordant atrioventricular connections to the L-looped ventricles in the presence of situs solitus.Both cases highlight that the relationship between the two ventricles within the ventricular mass is not always harmonious with the given atrioventricular connection.Such disharmony between the connections and relationships requires careful assessment of the three basic facets of cardiac building blocks,namely their morphology,the relationship of their component parts,and their connections with the adjacent segments.3D imaging and printing can now facilitate an otherwise difficult diagnosis in such complex situations.Rotation of either the 3D images or the models permit accurate assessment of the ventricular topologic pattern by creating the right ventricular en-face septal view,thus facilitating placement of the observer’s hands.As we now emphasize,an alternative approach,which might prove more attractive to imagers,is to rotate the ventricular mass to provide the ventricular apical view,thus permitting determination of the ventricular relationship without using the hands.展开更多
文摘Aims:Evidence is emerging that,in the setting of isomerism,the atrial and bronchial arrangement are not always concordant,nor are these patterns always harmonious with the arrangement of the abdominal organs.We aimed to evaluate the concordance between these features in a cohort of patients with cardiac malformations in the setting of known isomerism,seeking to determine whether it was feasible to assess complexity on this basis,in this regard taking note of the potential value of bronchial as opposed to appendage morphology.Methods and Results:We studied 78 patients known to have isomerism of the bronchuses,43 with right and 35 with left isomerism.Appendage anatomy could be determined in 49 cases(63%),all but one of these being concordant with bronchial anatomy.When assessing abdominal features,in only 59 cases(76%)was splenic morphology in keeping with the thoracic findings.As expected,right isomerism was associated with greater complexity of cardiac malformations,with an odds ratio of 6.53,with confidence intervals from 2.2–19.3(p<0.001).The odds were slightly decreased with thoraco-abdominal disharmony,when lesions shown to carry higher risk were then found in the setting of left isomerism.Conclusion:Harmony is excellent between bronchial and appendage isomerism,but less so with the arrangement of the abdominal organs.Right isomerism in our cohort,was indicative of a sixfold increase in intracardiac complexity.When discordance was found between the systems,however,the cardiac anomalies were less typical of the anticipated findings for right vs.left isomerism of the appendages.
文摘In the last issue,two case reports separately present examples of the extremely rare and complex congenital heart diseases that show concordant atrioventricular connections to the L-looped ventricles in the presence of situs solitus.Both cases highlight that the relationship between the two ventricles within the ventricular mass is not always harmonious with the given atrioventricular connection.Such disharmony between the connections and relationships requires careful assessment of the three basic facets of cardiac building blocks,namely their morphology,the relationship of their component parts,and their connections with the adjacent segments.3D imaging and printing can now facilitate an otherwise difficult diagnosis in such complex situations.Rotation of either the 3D images or the models permit accurate assessment of the ventricular topologic pattern by creating the right ventricular en-face septal view,thus facilitating placement of the observer’s hands.As we now emphasize,an alternative approach,which might prove more attractive to imagers,is to rotate the ventricular mass to provide the ventricular apical view,thus permitting determination of the ventricular relationship without using the hands.