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Atrial appendages and venoatrial connections in hearts from patients with visceral heterotaxy
1National Heart & Lung Institute, London, England.
Insights
Understanding atrial morphology and venoatrial connections in visceral heterotaxy (splenic syndromes) is crucial for surgical planning. This study clarifies key features for cardiac surgeons.
Area of Science:
- Anatomy
- Congenital Heart Disease
- Cardiac Surgery
Background:
- Venoatrial connections are critical for surgical decisions in visceral heterotaxy.
- The term "visceral heterotaxy" lacks specific morphologic detail relevant to surgeons.
- Clarifying atrial morphology is essential for effective surgical management.
Purpose of the Study:
- To elucidate the specific morphologic features of atria in visceral heterotaxy.
- To detail venoatrial connections in patients with visceral heterotaxy.
- To provide clarity for cardiac surgeons regarding atrial anatomy in these complex cases.
Main Methods:
- Postmortem examination of 183 hearts with visceral heterotaxy.
- Detailed analysis of systemic and pulmonary vein connections to the atria.
- Assessment of detailed atrial morphology, including appendage characteristics.
Main Results:
- Isomeric right appendages (smooth-walled vestibules) found in 58 cases.
- Isomeric left appendages (pectinate muscles to crux) found in 125 cases.
- Variations in inferior vena cava position and pulmonary vein connections were observed, differing between appendage types.
Conclusions:
- Distinguishing atrial appendage morphology is vital for accurate diagnosis in visceral heterotaxy.
- Understanding venoatrial connections is equally important for precise diagnosis.
- These distinctions are critical for guiding surgical strategies in splenic syndromes.
Background:
Venoatrial connections are important when choosing surgical options for patients with visceral heterotaxy. The precise morphology of the atriums, however, is often obfuscated by the term "visceral heterotaxy." This morphologic study aims to clarify the features of significance to the cardiac surgeon.
Methods:
We investigated 183 hearts from patients known from postmortem inspection to have so-called visceral heterotaxy. The connections of the systemic and pulmonary veins to the atriums, and the detailed morphology of the atriums, were examined in each case.
Results:
Pectinate muscles extended bilaterally to the crux in 125 hearts determined to have isomeric morphologically right appendages. The other 58 hearts all exhibited bilaterally smooth-walled vestibules, and were diagnosed as having isomeric left appendages. Bilateral superior caval veins were frequent in both groups. The inferior caval vein was right- or left-sided with equal frequency in both groups, but was interrupted only in hearts with isomeric left appendages. The pulmonary veins connected in extraatrial fashion in 48% of cases with isomeric right appendages, whereas, most commonly, pulmonary veins were connected bilaterally to the atriums in those with isomeric left appendages (60%).
Conclusions:
Both the morphology of the atrial appendages and the venoatrial connections need to be distinguished to establish precise diagnoses in patients with so-called visceral heterotaxy ("splenic syndromes").