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Subcostal two-dimensional echocardiographic recognition of a criss-cross heart with discordant ventriculo-arterial
Insights
Criss-cross atrioventricular (AV) relationship and ventriculo-arterial discordance can be identified using echocardiography. This complex congenital heart defect was further explained by post-mortem findings of ventricular torsion.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Criss-cross atrioventricular (AV) relationship is a rare congenital heart anomaly.
- Ventriculo-arterial discordance often accompanies complex cardiac malformations.
- Accurate diagnosis is crucial for patient management and outcomes.
Purpose of the Study:
- To demonstrate the echocardiographic identification of a rare criss-cross AV relationship with ventriculo-arterial discordance.
- To elucidate the complex cardiac anatomy and its embryological basis.
- To correlate echocardiographic findings with post-mortem investigations.
Main Methods:
- Two-dimensional echocardiography with a systematic subcostal approach.
- Angiocardiography for confirmation of echocardiographic findings.
- Post-mortem examination to determine the underlying cause of cardiac malformations.
Main Results:
- Echocardiography successfully identified the complex cardiac pathology, including the criss-cross AV relationship and ventriculo-arterial discordance.
- Angiocardiography confirmed the echocardiographic diagnosis.
- Post-mortem findings revealed secondary leftward ventricular torsion as the cause of the complex anatomy, including the criss-cross AV relationship.
Conclusions:
- Echocardiography is a valuable tool for diagnosing complex congenital heart defects like criss-cross AV relationships.
- Understanding the anatomical variations and their causes is essential for accurate diagnosis and treatment planning.
- Secondary ventricular torsion can lead to significant cardiac malformations, necessitating thorough investigation.
Abstract:
Two-dimensional echocardiography was performed on a patient with criss-cross atrioventricular (AV) relationship and ventriculo-arterial discordance. A systematic approach from the subcostal area revealed the complex cardiac pathology including the criss-cross AV relationship of right and left heart, indicating that this very abnormal relationship can be identified echocardiographically. The echocardiographic findings were confirmed by angiocardiography. Post-mortem investigation showed that much of the complexity, including the criss-cross AV relationship, had been caused by a secondary leftward torsion of the entire ventricular part of the heart.