Echocardiographic assessment of cardiac malposition

Abstract

Isolated dextrocardia or isolated levocardia almost invariably indicates the presence of a complex cardiac anomaly. An accurate anatomic diagnosis in patients with these malformations requires knowledge of the atrial position, the relative position of the ventricles (atrioventricular concordancy or discordancy) and the presence or absence of a ventricular septum. Fifteen patients were studied to demonstrate that diagnostic ultrasound, in conjunction with the plain chest roentgenogram, provides a noninvasive method for accurately assessing atrioventricular relations and arrangement of the great vessels, in the presence of isolated discordancy of the cardiac apex. The patients studied were aged 10 months to 17 years; seven had isolated dextrocardia, five had situs inversus totalis, two had isolated levocardia and one had levocardia with abdominal heterotaxy. Thirteen of the 15 patients evaluated by echocardiography underwent cardiac catheterization and angiography. The correct diagnosis was made from the echograms and plain chest roentgenograms alone in 11 of the 13 patients. We conclude that with echocardiography and the knowledge of atrial situs, it is possible to define accurately important anatomic relations before cardiac catheterization in patients with cardiac malposition.