Pathologic Anatomy of Dextrocardia and Its Clinical Implications

Abstract

This is a morphologic study of 41 cases of dextrocardia for the purpose of clarifying terminology and evaluating the clinical import of the morphologic data. Dextrocardias are classified as dextroversion, mirror-image dextrocardia, and mixed dextrocardia. When the atrial septum does not identifv the atria, it was found possible to make the presumptive diagnosis of dextroversion or mirror-image dextrocardia. The mutual relations of the visceral situs with the atrial situs, the presence or absence of splenic abnormalities, the type of dextrocardia, and the systemic and pulmonic venous return were investigated, as well as the type of complex that is characteristic of each type of dextrocardia. The most important morphologic data useful for clinical application were found to be the position of the aortic and pulmonic annuli, the course of the pulmonary trunk, the entry of the inferior and superior venae cavae, and the course of the anterior descending coronary artery.

Fetal dextrocardia: diagnosis and outcome in two tertiary centres

“…These findings are consistent with postnatal studies. [2][3][4][5][6][7] We concur that the term ''fetal dextrocardia'' indicates cardiac position only and does not give any indications of cardiac structure. As in postnatal studies, we did not find any case of hypoplastic left heart, in contrast to Walmsley et al, 13 who found two cases.…”

“…1 The term dextrocardia describes only the position of the cardiac axis and conveys no information regarding chamber organisation and structural anatomy of the heart. [2][3][4][5][6][7] In the postnatal period a broad spectrum of cardiac malformations is observed associated with dextrocardia, and the incidence varies according to the atrial situs. Complex cardiac heart malformations are found more often with situs solitus and situs ambiguus than with situs inversus.…”

How to determine atrial situs? Considerations initiated by 3 cases of absent spleen with a discordant anatomy between bronchi and atria.

“…Van Mierop, on many occasions, has pointed out that the atria in these conditions cannot be classified as either right or left on anatomical criteria, since both atria show characteristics of either a right or a left atrium (Van Mierop et al, 1964, 1972a. He coined the term 'isomerism' to indicate the symmetrical appearance of the atrial appendages under these circumstances (Van Mierop et al, 1964), while other investigators employed the terms 'uncertain' (Van Praagh et al, 1964b) or 'indeterminate' (Lev et al, 1968;Liberthson et al, 1973). The latter observers used the term 'indeterminate' for the situs of the atria when the atrial anatomy was highly abnormal, not necessarily associated with a symmetrical appearance of the atrial appendages.…”

Percutaneous closure of atrial septal defect with situs solitus and dextrocardia

“…6 In dextrocardia, the interatrial septum is directed anteriorly and to the right, with the morphologic right atrium situated to the right and slightly posteriorly, and the morphologic left atrium to the left and slightly anteriorly. 7 Our case highlights the technical difficulties encountered during device closure of ASD secundum in situs solitus associated with dextrocardia. Attention should be paid to the abnormal orientation of the interatrial septum and its relationship to the right and left atria.…”