Echocardiographic diagnosis and treatment of left atrial heterogeneity and associated malformations

doi:10.3877/cma.j.issn.1672-6448.2019.08.011

Abstract

Abstract:

Objective

To analyze the echocardiographic diagnosis of left atrial isomerism, and to explore the clinical prognosis and prognosis of such patients.

Methods

From January 2010 to October 2018, 47 cases of left atrial isomerism confirmed by echocardiography at Beijing Anzhen Hospital Affiliated to Capital Medical University were collected. The echocardiographic features, classification, surgical treatment, and prognosis were analyzed retrospectively.

Results

Among 47 patients with left atrial isomerism, 35 (35/47, 74.5%) had complex malformations, 10 (10/47, 21.3%) had simple malformations, and 2 (2/47, 4.2%) were not complicated with malformations. Among the 35 cases with complex malformations, 16 were polytypic in lung blood and 19 were hypotypic. Among the 47 patients with left atrial isomerism, 2 had abnormal visceral position, and 14 had abnormal cardiac position, including 11 (11/47, 23.4%) cases of right heart and 3 (3/47, 6.4%) cases of middle heart; 38 were complicated with polysplenic malformation (38/47, 80.9%) and 1 complicated with asymptomatic malformation; 42 (42/47, 89.4%) were complicated with bronchial and pulmonary malformations; 47 were combined with absence of the hepatic segment of the inferior vena cava (47/47, 100.0%); 23 (23/47, 48.9%) had abnormal superior vena cava connection; 47 (47/47, 100.0%) had abnormal hepatic venous connection; 6 (6/47, 12.8%) had abnormal pulmonary venous drainage; 9 (9/47, 19.1%) had abnormal electrocardiogram or dynamic electrocardiogram findings; 26 underwent orthodontic or palliative surgery, of which 21 had complicated malformations and 5 had simple malformations. Among the 26 cases undergoing surgical treatment, 4 died, all of whom had complicated malformations.

Conclusion

Left atrial isomerism patients are often complicated with cardiovascular and other organ malformations, which can be diagnosed by echocardiography. Echocardiography plays an important role in the diagnosis of left atrial isomerism and the accurate evaluation of associated malformations, as well as in the formulation of clinical treatment plans and the evaluation of the prognosis of patients.

Key words: Heart defects, congenital, Echocardiography, stress

Wanming Shi, Wenhong Ding, Jing Yang, Ying Mo, Xiaoran Liu. Echocardiographic diagnosis and treatment of left atrial heterogeneity and associated malformations[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2019, 16(08): 609-614.

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Figures/Tables 2

References 15

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畸形类型		手术方式	例数
复杂畸形（21例）		?	?
?	TECD	矫治术	1
?		Glenn术	2
?		肺动脉环缩术	1
?	PECD	矫治术	1
?	PECD	肺动脉环缩术	1
?	DORV＋PS	Blalock-Taussig分流术	2
?		Glenn术	1
?		Blalock-Taussig分流术＋Glenn术	1
?		Fontan术	1
?	PA＋VSD	Blalock-Taussig分流术	1
?	PA＋VSD	房间隔扩大补片术＋Blalock-Taussig分流术	1
?	TGA＋PS	Blalock-Taussig分流术＋Glenn术＋肺动脉扩大补片术	1
?	SV＋TGA＋PS	Glenn术	2
?	SV＋TGA＋PS	Fontan术	1
?	UCSS	肺动脉环缩术	1
?	DCRV	矫治术	1
?	COA	矫治术	1
?	PAPVC	矫治术	1
简单畸形（5例）		?	?
?	ASD	矫治术	2
?	PDA	动脉导管未闭封堵术	1
?	ASD＋VSD	矫治术	1
?	ASD＋VSD＋PDA	矫治术	1

畸形类型		手术方式	例数
复杂畸形（21例）		?	?
?	TECD	矫治术	1
?		Glenn术	2
?		肺动脉环缩术	1
?	PECD	矫治术	1
?	PECD	肺动脉环缩术	1
?	DORV＋PS	Blalock-Taussig分流术	2
?		Glenn术	1
?		Blalock-Taussig分流术＋Glenn术	1
?		Fontan术	1
?	PA＋VSD	Blalock-Taussig分流术	1
?	PA＋VSD	房间隔扩大补片术＋Blalock-Taussig分流术	1
?	TGA＋PS	Blalock-Taussig分流术＋Glenn术＋肺动脉扩大补片术	1
?	SV＋TGA＋PS	Glenn术	2
?	SV＋TGA＋PS	Fontan术	1
?	UCSS	肺动脉环缩术	1
?	DCRV	矫治术	1
?	COA	矫治术	1
?	PAPVC	矫治术	1
简单畸形（5例）		?	?
?	ASD	矫治术	2
?	PDA	动脉导管未闭封堵术	1
?	ASD＋VSD	矫治术	1
?	ASD＋VSD＋PDA	矫治术	1

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