Criss-cross heart electrocardiographic analysis. Bicentric study
De Rubens-Figueroa Jesús1, González-Rebeles Carlos2, De Micheli-Serra Alfredo3
1Echocardiography Laboratory, National Institute of Pediatrics, Mexico City, Mexico.
Insights
Electrocardiography aids in diagnosing criss-cross heart disease by revealing cardiac chamber positioning and associated defects. This non-invasive method provides crucial initial diagnostic orientation for echocardiographers.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Criss-cross heart disease is a rare congenital anomaly.
- Electrocardiographic (ECG) characteristics are not well-defined for early diagnosis.
Purpose of the Study:
- To compare electrocardiographic and echocardiographic findings in patients with criss-cross heart.
- To evaluate the diagnostic utility of ECG in identifying cardiac anatomy and defects.
Main Methods:
- Retrospective, cross-sectional study of 21 patients over 42 years.
- Analysis of 12-lead ECG parameters, including specialized leads for dextrocardia.
- Echocardiography to determine atrial situs, cardiac position, and relationships.
Main Results:
- ECG accurately predicted atrioventricular relationship (95.2%) and supero-inferior ventricles (81%).
- A superior QRS axis was observed in 71.4% of patients.
- ECG findings correlated with associated defects in 76.1% of cases.
Conclusions:
- ECG analysis can identify cardiac situs, chamber position, and associated defects in criss-cross heart.
- ECG serves as a valuable initial tool for diagnostic orientation in echocardiography.
- ECG contributes to the early diagnostic process of this rare condition.
Background:
Criss-cross is a rare congenital heart disease, of which the electrocardiographic characteristics are not precisely known for early diagnosis.
Objective:
To compare electrocardiographic and echocardiographic characteristics for the diagnosis of patients with criss-cross heart.
Methods:
A retrospective, comparative, cross-sectional study was carried out in two centers over 42 years. The age, sex, and 12‑lead basal electrocardiographic parameters were analyzed. In cases of dextrocardia, right-sided and posterior ECG were performed. Echocardiography was performed to obtain atrial situs, cardiac position, atrioventricular and ventricle arterial relationship, and associated cardiac defects. A descriptive analysis with measures of central tendency was done to assess the age of the population and proportions for the echocardiographic-electrocardiographic characteristics. A statistical analysis was used to find significant differences (p < 0.05) between the ECG and echocardiography groups.
Results:
Of the 21 patients studied, 14 (66%) were found with situs solitus, 10. (47.6%) with levocardia, 14 (66%) with atrio ventricular concordance, 13 (61.9%) with double outlet right ventricle and 17 (80.9%) with supero-inferior ventricles. The electrocardiogram predicted atrioventricular relationship in 20 cases (95.2%) (p < 0.01) and supero-inferior ventricles in 17 (81%), 15 (71.4%) had a superior QRS axis (82%) (p 0.02). Atrial and ventricular enlargement in the electrocardiogram correlated (p = 0.05) with associated defects in 16 cases (76.1%).
Conclusions:
The electrocardiographic analysis of these patients allows us to visualize the situs, position of the cardiac chambers, and associated defects in patients with criss-cross heart. It is useful for the diagnostic orientation of the echocardiographer and therefore contributes initially to the echocardiographic study.
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