Segregating bodily isomerism or heterotaxy: Potential echocardiographic correlations of morphological findings

Cornelia Tremblay, Rohit S. Loomba*, Peter C. Frommelt, Donald Perrin, Diane E. Spicer, Carl Backer, Robert H. Anderson

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background Bodily isomerism, also referred to as heterotaxy, involves predominantly the thoracic organs, although other organs are usually abnormally positioned. Previously assessed on the basis of splenic anatomy, it is now understood that isomerism is better segregated on the basis of atrial appendage morphology. This allows for anticipation of associated findings. We aimed to assess the accuracy of segregation based on the morphology of the atrial appendages and other structures more easily identified by echocardiography. Methods We reviewed postmortem specimens of hearts from the archives at four institutions categorised as obtained from patients with heterotaxy. The cardiac structures were analysed using sequential segmental analysis. Non-cardiac structures were also examined if available. Statistical analyses were performed to compare differences in the settings of right as opposed to left isomerism. Results Specimens were available from 188 patients. Of these, 57 had left isomerism, and 131 had right isomerism. Atrial appendages were isomeric in all patients. A coronary sinus was found only in left isomerism, whereas a terminal crest, or a Eustachian valve, was found only in right isomerism. Interruption of the inferior caval vein was associated with left isomerism, whereas totally anomalous pulmonary venous connection was associated with right isomerism. Conclusion Isomerism is uniformly segregated on the basis of the morphology of the atrial appendages, itself defined by the extent of the pectinate muscles. Other features such as the presence of a coronary sinus and systemic venous return can further help with such segregation of isomerism.

Original languageEnglish (US)
Pages (from-to)1470-1480
Number of pages11
JournalCardiology in the young
Volume27
Issue number8
DOIs
StatePublished - Oct 1 2017

Fingerprint

Isomerism
Atrial Appendage
Coronary Sinus
Venae Cavae
Echocardiography
Veins
Anatomy
Thorax

Keywords

  • Heterotaxy
  • atrial appendages
  • coronary sinus
  • echocardiography
  • isomerism

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

Cite this

Tremblay, Cornelia ; Loomba, Rohit S. ; Frommelt, Peter C. ; Perrin, Donald ; Spicer, Diane E. ; Backer, Carl ; Anderson, Robert H. / Segregating bodily isomerism or heterotaxy : Potential echocardiographic correlations of morphological findings. In: Cardiology in the young. 2017 ; Vol. 27, No. 8. pp. 1470-1480.
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abstract = "Background Bodily isomerism, also referred to as heterotaxy, involves predominantly the thoracic organs, although other organs are usually abnormally positioned. Previously assessed on the basis of splenic anatomy, it is now understood that isomerism is better segregated on the basis of atrial appendage morphology. This allows for anticipation of associated findings. We aimed to assess the accuracy of segregation based on the morphology of the atrial appendages and other structures more easily identified by echocardiography. Methods We reviewed postmortem specimens of hearts from the archives at four institutions categorised as obtained from patients with heterotaxy. The cardiac structures were analysed using sequential segmental analysis. Non-cardiac structures were also examined if available. Statistical analyses were performed to compare differences in the settings of right as opposed to left isomerism. Results Specimens were available from 188 patients. Of these, 57 had left isomerism, and 131 had right isomerism. Atrial appendages were isomeric in all patients. A coronary sinus was found only in left isomerism, whereas a terminal crest, or a Eustachian valve, was found only in right isomerism. Interruption of the inferior caval vein was associated with left isomerism, whereas totally anomalous pulmonary venous connection was associated with right isomerism. Conclusion Isomerism is uniformly segregated on the basis of the morphology of the atrial appendages, itself defined by the extent of the pectinate muscles. Other features such as the presence of a coronary sinus and systemic venous return can further help with such segregation of isomerism.",
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Segregating bodily isomerism or heterotaxy : Potential echocardiographic correlations of morphological findings. / Tremblay, Cornelia; Loomba, Rohit S.; Frommelt, Peter C.; Perrin, Donald; Spicer, Diane E.; Backer, Carl; Anderson, Robert H.

In: Cardiology in the young, Vol. 27, No. 8, 01.10.2017, p. 1470-1480.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Segregating bodily isomerism or heterotaxy

T2 - Potential echocardiographic correlations of morphological findings

AU - Tremblay, Cornelia

AU - Loomba, Rohit S.

AU - Frommelt, Peter C.

AU - Perrin, Donald

AU - Spicer, Diane E.

AU - Backer, Carl

AU - Anderson, Robert H.

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Background Bodily isomerism, also referred to as heterotaxy, involves predominantly the thoracic organs, although other organs are usually abnormally positioned. Previously assessed on the basis of splenic anatomy, it is now understood that isomerism is better segregated on the basis of atrial appendage morphology. This allows for anticipation of associated findings. We aimed to assess the accuracy of segregation based on the morphology of the atrial appendages and other structures more easily identified by echocardiography. Methods We reviewed postmortem specimens of hearts from the archives at four institutions categorised as obtained from patients with heterotaxy. The cardiac structures were analysed using sequential segmental analysis. Non-cardiac structures were also examined if available. Statistical analyses were performed to compare differences in the settings of right as opposed to left isomerism. Results Specimens were available from 188 patients. Of these, 57 had left isomerism, and 131 had right isomerism. Atrial appendages were isomeric in all patients. A coronary sinus was found only in left isomerism, whereas a terminal crest, or a Eustachian valve, was found only in right isomerism. Interruption of the inferior caval vein was associated with left isomerism, whereas totally anomalous pulmonary venous connection was associated with right isomerism. Conclusion Isomerism is uniformly segregated on the basis of the morphology of the atrial appendages, itself defined by the extent of the pectinate muscles. Other features such as the presence of a coronary sinus and systemic venous return can further help with such segregation of isomerism.

AB - Background Bodily isomerism, also referred to as heterotaxy, involves predominantly the thoracic organs, although other organs are usually abnormally positioned. Previously assessed on the basis of splenic anatomy, it is now understood that isomerism is better segregated on the basis of atrial appendage morphology. This allows for anticipation of associated findings. We aimed to assess the accuracy of segregation based on the morphology of the atrial appendages and other structures more easily identified by echocardiography. Methods We reviewed postmortem specimens of hearts from the archives at four institutions categorised as obtained from patients with heterotaxy. The cardiac structures were analysed using sequential segmental analysis. Non-cardiac structures were also examined if available. Statistical analyses were performed to compare differences in the settings of right as opposed to left isomerism. Results Specimens were available from 188 patients. Of these, 57 had left isomerism, and 131 had right isomerism. Atrial appendages were isomeric in all patients. A coronary sinus was found only in left isomerism, whereas a terminal crest, or a Eustachian valve, was found only in right isomerism. Interruption of the inferior caval vein was associated with left isomerism, whereas totally anomalous pulmonary venous connection was associated with right isomerism. Conclusion Isomerism is uniformly segregated on the basis of the morphology of the atrial appendages, itself defined by the extent of the pectinate muscles. Other features such as the presence of a coronary sinus and systemic venous return can further help with such segregation of isomerism.

KW - Heterotaxy

KW - atrial appendages

KW - coronary sinus

KW - echocardiography

KW - isomerism

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