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[Univentricular heart: angiographic features in 31 patients]
Insights
Angiographic evaluation of univentricular heart revealed common discordant ventricle-arterial junctions in left ventricle types and frequent trabecular pouches in right ventricle types. Pulmonary flow obstruction is prevalent across all types, particularly in the undetermined category.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Medical Imaging
Background:
- Univentricular heart (UVH) is a complex congenital heart defect.
- Accurate diagnosis and characterization of UVH subtypes are crucial for patient management.
- Angiography plays a vital role in delineating the intricate anatomy of UVH.
Purpose of the Study:
- To evaluate the angiographic features of different morphological types of univentricular heart.
- To identify characteristic anatomical findings associated with each UVH subtype.
Main Methods:
- Retrospective analysis of 31 patients with univentricular heart.
- Classification into left ventricle type, right ventricle type, and undetermined groups.
- Detailed assessment of atrio-ventricular junction, rudimentary chamber position, ventricle-arterial junction, great artery relationship, and coronary artery origins.
Main Results:
- Left ventricle type (16 cases) showed frequent discordant ventricle-arterial junctions and single atrio-ventricular valves.
- Right ventricle type (9 cases) frequently exhibited trabecular pouches.
- Undetermined type (6 cases) commonly presented with single atrio-ventricular valves and pulmonary flow obstruction (stenosis or atresia).
- Anomalous coronary artery origins were observed in a significant proportion of cases.
Conclusions:
- Discordant ventricle-arterial connections are common in left ventricle type UVH.
- Trabecular pouches are characteristic of right ventricle type UVH.
- Single atrio-ventricular valves are frequent in the undetermined type.
- Pulmonary flow obstruction is a common complication across all UVH types, more so in the undetermined group.
- Anomalous coronary artery origins from the aortic sinus are frequently observed.
Purpose:
Evaluation of angiographic features of univentricular heart.
Methods:
Thirty-one patients were divided into 3 groups according to morphological type of univentricular heart: left ventricle type, right ventricle type and undetermined. They were studied for atrio-ventricular junction, position of rudimentary chamber in relation to principal chamber, ventricle-arterial junction, the position of the two great arteries in relation to each other and whenever possible, the origin of the coronary arteries.
Results:
There were 16 cases of left ventricle type with A-V junction through 2 valves in 8 and through single valve in 6. The rudimentary chamber position was superior and to the right in 4 cases of dextrocardia and superior and to the left in 8 of levocardia. The ventricle-arterial junction was discordant in 9 patients and concordant in 4, double outlet of rudimentary chamber in 2 and single outlet in 1. The aorta was anterior to the pulmonary artery in 13 patients. Anomalous origin of the coronary arteries occurred in 5 of 9 cases studied. Right ventricle type occurred in 9 patients with absence of one of the A-V junctions in 5. Trabecular pouch was seen in 6 patients, posterior and inferior positioned in all of them. Double outlet from principal chamber occurred in 8 patients. The aorta was anterior in 66.6%. Undetermined type occurred in 6 patients with A-V junction through single valve in 5. In 3 there was double outlet from principal chamber showing pulmonary stenosis and in the remaining 3 there was pulmonary atresia.
Conclusion:
Discordant ventricle-arterial junction is common for left ventricle type; trabecular pouch is frequent in right ventricle type; single A-V valve is common for undetermined type; obstruction of pulmonary flow happens in all 3 types but it is more frequent in undetermined type; the aorta is anterior to the pulmonary artery in most cases; it is common the anomalous origin of the coronary arteries from the aortic sinus.