An unusual ventricular loop associated with right juxtaposition of the atrial appendages

Disharmonious Ventricular Relationship and Topology for the Given Atrioventricular Connections. Contemporary Diagnostic Approach Using 3D Modeling and Printing

“…In their second case, which showed situs solitus with a left-sided heart, discordant atrioventricular connections were associated with right-handed ventricular topology, in this instance with right juxtaposition of the atrial appendages. Seo et al [5] then described a case similar to the one reported by Wagner et al [3]. The two cases reported in this issue now show further examples of the hearts with disharmony between the atrioventricular connection and the ventricular relationship and topology [1,2].…”

“…The two cases reported in this issue now show further examples of the hearts with disharmony between the atrioventricular connection and the ventricular relationship and topology [1,2]. It is surely of note that all 6 cases reported to date have had juxtaposition of the atrial appendages, 5 on the right and 1 on the left [1][2][3][4][5]. Of interest, the ventricular apex pointed to the left in all 5 with right juxtaposition, while it pointed to the right in the example with left juxtaposition [1][2][3][4][5].…”

“…Although the two cases appear distinctly different, they share common features including: first, visceral and atrial situs solitus with right juxtaposition of the atrial appendages, second, concordant connection of the atria to the underlying ventricles, which show an L-loop relationship or left-handed topologic pattern, and third, double outlet right ventricle with a remote perimembranous ventricular septal defect. Previous reports describing the presence of a disharmonious ventricular loop pattern or topology for the given atrioventricular connection are rare [3][4][5]. These earlier reports were all based either on pathological specimens or two-dimensional imaging.…”

Echocardiographic characteristics of the criss-cross heart

“…In other words, the unusual twisting of the ventricular mass occurs in such a fashion to place the right ventricular inlet superior and anterior to the left ventricular inlet [7]. In a few cases, nonetheless, opposite twisting has been observed such that the right ventricular inlet is positioned inferior and posterior relative to the left ventricular inlet [8,9]. In general, rather than the two inlets being parallel one to the other, they are positioned superoinferiorly, this feature accounting for the inability to image the four chambers and the two atrioventricular valves in the same plane simultaneously.…”

Concordant Atrioventricular Connection to L-Looped Ventricles with the Left Ventricle on Top of the Right Ventricle in Situs Solitus: A Case Report with 3D Modelling and Printing

“…The case described in this report showed an extremely unusual relationship between the chambers, including concordant atrioventricular connection to L-looped ventricles in the setting of situs solitus and levocardia, right-sided juxtaposition of the atrial appendages, superoinferiorly related ventricles with the left ventricle on top of the right ventricle, and double outlet right ventricle with the arterial trunks inferiorly located in the posterior mediastinum above the diaphragm. Concordant connection of the normally related atria to the L-looped ventricles is extremely rare [3][4][5]. Anderson et al described that there was disharmony between the atrioventricular connection and segmental combinations in these hearts [4].…”