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Polysplenia syndrome. A study of five new cases
Insights
Polysplenia syndrome in children often presents with congenital heart disease, including atrial septal defects and interrupted inferior vena cava. An unusual P wave axis on ECG can aid in early diagnosis.
Area of Science:
- Pediatric Cardiology
- Medical Genetics
- Developmental Biology
Background:
- Polysplenia syndrome is a rare congenital disorder characterized by multiple spleens and visceral heterotaxy.
- It is frequently associated with complex congenital heart disease, posing diagnostic and therapeutic challenges.
Observation:
- This study describes five children diagnosed with polysplenia syndrome.
- Cardiac anomalies identified included interrupted inferior vena cava with azygos continuation, single atrium or large atrial septal defect, ventricular septal defects, and primitive ventricle.
- Other observed anomalies were central liver, right-sided stomach, and bilateral bilobed lungs.
Findings:
- All five patients had an interrupted inferior vena cava and atrial septal defects.
- Electrocardiogram (ECG) findings in four patients revealed a negative P wave in leads II, III, and AVF, indicating a leftward and superiorly directed P wave axis.
- This specific P wave axis is a potential diagnostic marker for polysplenia syndrome in infants with congenital heart disease.
Implications:
- Early recognition of polysplenia syndrome is crucial due to the surgical correctability of associated cardiac anomalies.
- Identifying the characteristic P wave axis on ECG can facilitate timely diagnosis and intervention in affected infants.
- This highlights the importance of a multidisciplinary approach in managing complex congenital conditions.
Abstract:
Five children with polysplenia syndrome are described. Cardiac catheterization or postmortem examination revealed the following cardiac anomalies: interruption of the inferior vena cava with azygos (or hemiazygos) continuation to the left superior vena cava and a single atrium or a large atrial septal defect in all five children; a ventricular septal defect in three; and a primitive ventricle in one case. Other anomalies found were: central liver in all five; a right-sided stomach in three; and multiple small spleens and bilateral left, bilobed lungs--found on autopsy--in two of the children. In four of the five patients, whose ECG was available, a negative P wave was present in leads II, III and AVF. This leftward and superiorly directed P wave axis should suggest a diagnosis of polysplenia syndrome in an infant with congenital heart disease. The cardiac anomalies are surgically correctable; therefore, early recognition of this syndrome is of practical importance.