Related Experiment Video
Updated: Sep 20, 2026
Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 17, 2014
Atrial morphology in hearts with congenitally corrected transposition of the great arteries: implications for the
Rajnish Juneja1, Edward Rowland, Siew Yen Ho
1Department of Cardiology, St. George's Hospital NHS Trust, National Heart & Lung Institute, Faculty of Medicine, Imperial College, and Royal Brompton and Harefield NHS Trust, London, United Kingdom.
Insights
Hearts with congenitally corrected transposition of the great arteries (ccTGA) have a shorter posterior septal margin and coronary sinus (CS) isthmus. This anatomical difference increases risks during septal puncture and radiofrequency ablation procedures.
Area of Science:
- Cardiovascular Anatomy
- Congenital Heart Disease
- Electrophysiology
Background:
- Congenitally corrected transposition of the great arteries (ccTGA) presents unique anatomical challenges.
- Septal puncture and coronary sinus (CS) cannulation can be difficult in ccTGA patients.
Purpose of the Study:
- To investigate the anatomical features of the right atrium in hearts with ccTGA.
- To assess the implications for interventional procedures like septal puncture and ablation.
Main Methods:
- Comparative anatomical study of nine ccTGA hearts and eight control hearts.
- Measurement of right atrial septal dimensions, oval fossa (OF) size, and CS isthmus length.
- Statistical analysis using Mann-Whitney test.
Main Results:
- Hearts with ccTGA exhibited a significantly shorter posterior septal margin compared to controls.
- The CS isthmus was also significantly shorter in ccTGA hearts.
- Abnormal positioning of the CS opening was observed in some ccTGA cases.
Conclusions:
- The reduced posterior septal margin in ccTGA may elevate the risk of cardiac perforation during posterior septal puncture.
- Shorter CS isthmus length and atypical CS ostial location are critical considerations for radiofrequency ablation in ccTGA.
Introduction:
In view of the possible need for septal puncture to ablate left-sided lesions and the occasional difficulty in coronary sinus (CS) cannulation, we investigated relevant anatomic features in the right atrium of hearts with congenitally corrected transposition of the great arteries (ccTGA).
Methods And Results:
Nine hearts with ccTGA and an intact atrial septum and eight weight-matched normal hearts were examined by studying the "septal" aspect of the right atrium with reference to the oval fossa (OF). The anterior margin was arbitrarily measured as the shortest distance from the OF to the superior mitral/tricuspid annulus. The posterior margin was measured from the OF to the posterior-most edge of the right atrial "septal" surface. The total "septal" surface width was measured at the middle of the OF. The stretched OF dimensions and CS isthmus length were noted. Mann-Whitney test was used to compare absolute and indexed dimensions, i.e.. normalized to total width. The posterior margin in hearts with ccTGA was shorter than in controls (6.3+/-2.4 mm vs 11+/-1.9 mm, P < 0.001; normalized margin P = 0.09). The CS isthmus also was significantly shorter (5.3+/-2.7 mm vs 11.4+/-2.2 mm, P < 0.001). In two hearts with ccTGA, the CS opening into the right atrium was on the same side of the eustachian valve as the inferior caval vein.
Conclusion:
The shorter posterior "septal" margin in hearts with ccTGA may increase the risk of exiting the heart while performing septal puncture when pointing the needle posteriorly. The shorter CS isthmus and the abnormal location of the CS opening in some of these hearts are important when contemplating radiofrequency ablation in this area.
Related Concept Videos
01:16Chambers of the Heart
Deoxygenated blood from the body is received in the right...
01:27Development of the Heart
As the embryo undergoes lateral folding, these paired tubes approach each other, merging into a single primitive heart tube by...