Prenatal Diagnosis and Postnatal Outcome of Eight Cases with Criss-Cross Heart – A Multicenter Case Series

Abstract

Objective Criss-cross heart (CCH) is a rare congenital cardiac defect defined by crossing of ventricular inflow streams contributing to less than 0.1 % of all congenital heart anomalies. Due to its rarity and complexity, prenatal diagnosis in these patients remains challenging. We sought to describe prenatal findings and postnatal course in eight cases of prenatally diagnosed CCH. Methods This is a retrospective case series of prenatally diagnosed CCH in three centers between 2010–2017. We reviewed fetal echocardiograms as well as postnatal clinical charts and surgical reports. Results 8 cases of CCH were included. The median gestational age at diagnosis was 27 weeks. 7 patients were found with situs solitus, one fetus with situs ambiguous. In all patients, the four-chamber view was abnormal. There was atrioventricular discordance in half of the patients, while all patients showed ventriculoarterial discordance. All patients were found with additional cardiac anomalies, including ventricular septal defect, double outlet right ventricle, right aortic arch, atrial septal defect and pulmonary stenosis. Three patients underwent amniocentesis without pathological findings. All patients were born alive at a median gestational age of 38 + 2 weeks and survived our median follow-up of 181 days. Conclusion CCH can be diagnosed prenatally by detailed fetal echocardiography when observing an abnormal four-chamber view with crossing of inflow streams into both ventricles and a lack of parallel orientation of the atrioventricular valve axis due to a clockwise or counterclockwise rotation of the ventricular mass along its axis. With the help of prenatal ultrasound, parental guidance and counselling as well as postnatal pediatric cardiac management can be warranted.

Prenatal diagnosis of criss-cross heart with congenitally corrected transposition of the great arteries – detection and fetal echocardiography monitoring with one-year postnatal follow-up

“…In the years 2008-2020 progress in ultrasound technology and experience in fetal echocardiography enabled the diagnosis of CCH or cc-TGA prenatally [6][7][8]. However, the combination of criss-cross heart and corrected TGA was found only in individual cases (Table 2) [9,10].…”