Hostname: page-component-5d59c44645-n6p7q Total loading time: 0 Render date: 2024-02-28T13:59:42.844Z Has data issue: false hasContentIssue false

Arrangement of the systemic and pulmonary venous components of the atrial chambers in hearts with isomeric atrial appendages

Published online by Cambridge University Press:  19 August 2008

Jee-Yeon Min
Affiliation:
Department of Diagnostic Radiology, Sungkyunkwan University of MedicineSeoul
Chi-Yon Kim
Affiliation:
Department of Pathology, Seoul National University College of Medicine, Seoul.
Mee Hye Oh
Affiliation:
Department of Pathology, Sejong Heart Institute, Pucheon, Korea
Yi Kyeong Chun
Affiliation:
Department of PathologySungkyunkwan University of MedicineSeoul
Yeon-Lim Suh
Affiliation:
Department of PathologySungkyunkwan University of MedicineSeoul
I-Seok Kang
Affiliation:
Department of Paediatrics, Sungkyunkwan University School of Medicine, Seoul
Heung-Jae Lee
Affiliation:
Department of Paediatrics, Sungkyunkwan University School of Medicine, Seoul
Jeong-Wook Seo*
Affiliation:
Department of Pathology, Seoul National University College of Medicine, Seoul.
*
Jeong-Wook Seo MD, Department of Pathology, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110–779, Korea, Tel: 82–2–740–8268; Fax: 82–2–765–5600; E-mail: jwseo@plaza.snu.ak.kr

Abstract

Background

The morphological definition of atrial chambers, and the determination of atrial laterality, are based on analysis of the structure of the atrial appendages. The systemic and pulmonary venous connections to the heart, nonetheless, are important in the management of patients having isomeric appendages. In this study, therefore, we analysed the morphology of the postero-superior walls of the atrial chambers so as to provide evidence concerning the morphogenetic background of those hearts, and to improve operative management.

Methods

We reviewed 15 autopsied specimens with isomeric right appendages, and 10 with isomeric left appendages, paying particular attention to the morphology of the systemic and pulmonary venous connections. The postero-superior walls of the atrial chambers can be made up of the atrial body, the systemic venous components, or the pulmonary venous component. We analysed the contributions made by each of these components.

Results

The postero-superior walls of the atrial chambers were markedly variable, but could be grouped into five patterns. Bilaterally well-developed systemic venous components and absence of the pulmonary venous component within the hypoplastic atrial body were present in 9 hearts with extracardiac pulmonary venous connections in the setting of right isomerism. Bilaterally well-developed systemic venous components, and a hypoplastic pulmonary venous component within the hypoplastic atrial body, were present in 5 hearts with intracardiac pulmonary venous connections in right isomerism. Bilaterally well-developed systemic venous components, and a hypoplastic pulmonary venous component within the sizable atrial body, were present in 1 heart with an intracardiac pulmonary venous connection in right isomerism. A well-developed pulmonary venous component within the atrial body, and hypoplasia of one systemic venous component, were present in 7 hearts with left isomerism. A well-developed pulmonary venous component within the atrial body, and hypoplasia of bilateral systemic venous components, were present in 3 hearts with left isomerism.

Conclusions

The postero-superior walls of the atrial chambers in hearts with isomeric atrial appendages can be analysed on the basis of a compound structure made of bilateral systemic venous components, a central pulmonary venous component, and the body of the atrium. Hearts with isomeric right appendages have absence or hypoplasia of the pulmonary venous component, while hearts with isomeric left appendages have hypoplastic systemic venous components.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2000

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Seo, JW, Brown, NA, Ho, SY, Anderson, RH. Abnormal laterality and congenital cardiac anomalies: Realationship of visceral and cardiac morphologies in the iv/iv mouse. circulation 1992; 86: 642650.Google Scholar
2.Devine, WAWhat if Ivemark had suggested the term ‘syndrome of visceral symmetry with asplenia’ instead of ‘asplenta, a teratologic syndrome of visceral heterolaxy?’. cardiol Young 1992; 2 108113.Google Scholar
3.Caruso, G, Becker, AE. How to determine atrial situs ?. Br Heart J 1979; 41: 559567.Google Scholar
4.van Mierop, LH, Gessner, IH, Schiebler, GL. Asplenia and polysplenia syndromes. Birth Defects 1972; 8: 3644.Google Scholar
5.peoples, WM, Moller, JH, Edwards, JE. Polysplenia; a review if 194 cases. pediatr cardiol 1983; 4: 129137.Google Scholar
6.van praagh, R, van praagh, S. Artial isomerism in the heterotaxy sydromes with asplenia, or polysplenia, or normally formed spleen: an erroneous concept. Am J cardiol 1990 66: 15041506.Google Scholar
7.Uemura, H, Ho, SY, Devine, WA, Kilpatrick, LL, Anderson, RH. Artial morphology in visceral heterotaxy. Ann Thorac surg. 1995; 60: 561569.Google Scholar
8.van praagh, SKreutzer, J, Alday, L, van praagh, R. systemic and pulmonary venous connections in visceral heterotaxy with emphasis on the diagnosis of the atrial situs: a study of 109 postmortem cases. In: clark, EB, Takao, A Developmental cardiology:Morphogenesis and function New YourkFutura 1990; 671727.Google Scholar
9.Jewell, FM, Joffe, Hs,Wilde, P. Left atrial isomerism with bronchoatrial discordance. cardiol Young 1993; 3: 225228.Google Scholar
10.Macartney, FJ, Zuberbuhler, JR, Anderson, RH. Atrial morphology and venous connections. Br Heatr J 1980; 44: 657667.Google Scholar
11.Uemura, H, Anderson, RH, Yaghihara, T. surgical implications in hearts with isomeric atrial appendages. Adv card surg 1996; 7: 581615.Google Scholar
12.Anderson, RHUnderstanding the nature of congenital division of the artial chambers. Br Heart J 1992;68: 13.Google Scholar
13.seo, JW, Kim, YH. Morphology of the embryonic atrial chambers in the mouse with iv/v mutation In: claek, EB, Markwald, RR, Takao, A Developmental mechanisme of heart disease New YOrkFutura 1995 545553.Google Scholar
14.Hagler, DJO–Leary, PW. cardiac malposition and abnormalities of artial and visceral situs. In: Moss and AdamsHeart Disease in Indants, children and Adolescents (5th edn). Emmanouilides, GC, Riemenschneider, TA, Allen, HD, Gutgessll, HP (eds) BaltimorWilliams & Wilkins 1995: pp1307–1336.Google Scholar
15.Humes, RA, Feldt, RH, porter, CJ, Julsrud, PR, puga, FJ, Danielson, GKThe modified Fontan operation for asplenia and polysplenia syndormes J Thorac cerdiavasx surg 1988; 96: 212218.Google Scholar
16.Culbertson, CB, George, BL, Day, RW, Laks, H, Williams, RG.Factors influencing survival of patients with heterotaxy syndrome undergoing the Fontan procedure. J Am Coll Cardiol 1992; 20: 678684.Google Scholar
17.Kawashima, Y, Matsuda, H, Natio, Y, Yaghihara, T, Kadoba, K, Matsuki, O. Biventricular repair of cardiac isomerism with common atrioventricular canal with the aid of endocardial cushion prosthesis. J horac Cardiovasc Surg 1993; 106:248254.Google Scholar
18.Michielon, G, Gharagozloo, F, Julsrud, PR, Danielson, GK, Puga, FJ. Modified Fontan operation in the presence of anomalies of systemic and pulmonary venous connection. Circulation 1993;88: 141148.Google Scholar
19.Srivastava, D, Preminger, T, Lock, JE, Mandell, V,Keane, JF, Mayer, JE, Kazakewich, H, Spevak, PJ. Hepatic venous blood and the development of pulmonary arteriovenous malformation in congenital heart disease. Circulation 1995; 92: 12171222.Google Scholar
20.Kang, IS, Min, J-Y, Lee, HJ, Bae, EJ. Rudimentary superior vena cava as a potential collateral channel after bidirectional cavopulmonary shunt in patients with right atrial isomerism. 2nd J World Congress of Pediatrcardiol&Cardiac Surg (Abstract) 1997:P360Google Scholar
21.HO, SY, Cook, A, Anderson, RH, Allan, LD, Fagg, NLK. Isomerisom of the atrial appendages in the fetus. pediatr pathol 1991; 11: 589608.Google Scholar
22.Ho, SY, Seo, JW, Brown, NA, Cook, AC, Fagg, NLK, Anderson, RH. Morphology of the sinus node in human and mouse herats with isomerism oh the atrial appendages. Br Heart J 1995; 74: 437442.Google Scholar
23.Rubino, M, Van Praagh, S, Kadoba, KPessoto, R, Van, Praagh R. Systemic and pulmonary venous connections in visceral heterotaxy with asplenia. J Thorac Cardiovasc Surg 1995; 110:641650.Google Scholar