[Echocardiographic evaluation of crisscross heart]

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease
• Diagnostic Imaging

Background:

• Crisscross heart (CCH) is a rare congenital anomaly characterized by abnormal spatial arrangement of cardiac chambers and great arteries.
• Understanding the atrioventricular (AV) connection and AV segmental situs is crucial for accurate diagnosis and management of CCH.

Purpose of the Study:

• To investigate the patterns of atrioventricular connection and atrioventricular segmental situs in patients diagnosed with crisscross heart.
• To assess the diagnostic efficacy of echocardiography in identifying these complex cardiac anomalies.

Main Methods:

• Retrospective analysis of echocardiographic data from ten consecutive patients with crisscross heart.
• Comparison of echocardiographic findings with results from X-ray angiocardiography and 64-slice multi-detector row computed tomography (MDCT) or MRI.

Main Results:

• Echocardiography demonstrated 100% positive rate and specificity in visualizing the crossing of atrioventricular valves in subxiphoid or apical 4-chamber views.
• Varied ventricular septal orientation (horizontal in 9, vertical in 1) and complex atrioventricular connections and segmental situs were observed, with discordance in one case.
• Associated ventriculoarterial connections included DORV (6), TGA (2), and C-TGA (1).

Conclusions:

• Echocardiography is a valuable tool for diagnosing crisscross heart, with specific views like subxiphoid long-axis and apical 4-chamber being key.
• The atrioventricular connection and atrioventricular segmental situs in CCH are intricate and do not always correlate, necessitating individual assessment.