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Table of Contents   
LETTER TO EDITOR  
Year : 2021  |  Volume : 14  |  Issue : 2  |  Page : 250-251
Anatomical substrate for biventricular repair in patients with left isomerism


Department of Pediatric Cardiology, Policlinico Umberto I, Sapienza University of Rome, Italy

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Date of Submission21-Oct-2020
Date of Acceptance05-Feb-2021
Date of Web Publication03-May-2021
 

How to cite this article:
Madrigali A, Putotto C, Marino B, Versacci P. Anatomical substrate for biventricular repair in patients with left isomerism. Ann Pediatr Card 2021;14:250-1

How to cite this URL:
Madrigali A, Putotto C, Marino B, Versacci P. Anatomical substrate for biventricular repair in patients with left isomerism. Ann Pediatr Card [serial online] 2021 [cited 2021 Jun 21];14:250-1. Available from: https://www.annalspc.com/text.asp?2021/14/2/250/315282




Sir,

We read the interesting paper by Bansal et al. on anatomical surgical repair in a patient with left isomerism of the atrial appendages, l-looped ventricles, concordant ventriculoatrial connection, and mirrored image tetralogy of Fallot.[1]

The authors must be congratulated both for the accurate diagnosis and for the proper surgical treatment.

As reported by the authors,[1] biventricular repair in patients with heterotaxy and left isomerism of the atrial appendages was previously described as more feasible compared to cases of right isomerism, due to a less complex cardiac anatomy.[2],[3]

In fact, in the left isomerism, the pulmonary venous connections are intracardiac, the atrioventricular canal defect is usually partial and balanced, and the ventriculoarterial connections are frequently concordant both with d- and l-looped ventricles,[3],[4] while in the right isomerism, the great arteries (GAs) are virtually always parallel to each other with the anterior aorta (transposition on double-outlet right ventricle).

Usually, in the left isomerism, the GAs are normally related in patients with d-looped ventricles or “inverted” normally related (mirror image) in patients with l-looped ventricles.[3],[5]

Then, in a large proportion of children with left isomerism, the “ambiguity” is only at atrial level, while the ventricular and the arterial segments are either solitus, with d-looped ventricles and normally related GA, or inversus, with l-looped ventricles and inverted normally related GA as in the case described by Bansal et al.[1]

These anatomic patterns can facilitate the surgical biventricular repair[2],[3] and could indicate a better morphogenetic comprehension of heart defects in patients with heterotaxy and left isomerism of atrial appendages.[5]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Bansal N, Ghosh R, Sankhyan LK, Chatterjee S, Chatterjee S, Bose S. Left isomerism with bilateral superior vena cava, interrupted inferior vena cava and tetralogy of Fallot. Ann Pediatr Cardiol 2020;13:364-7.  Back to cited text no. 1
    
2.
Hirooka K, Yagihara T, Kishimoto H, Isobe F, Yamamoto F, Nishigaki K, et al. Biventricular repair in cardiac isomerism: Report of seventeen cases. J Thorac Cardiovasc Surg 1995;109:530-5.  Back to cited text no. 2
    
3.
Carotti A, Marino B, Oppido G, Marcelletti C. Biventricular repair in patients with left isomerism. Thoracic 1995;110:1151-2.  Back to cited text no. 3
    
4.
Marino B, Capolino R, Digilio MC, Di Donato R. Transposition of the great arteries in asplenia and polysplenia phenotypes. Am J Med Genet 2002;110:292-4.  Back to cited text no. 4
    
5.
Vairo U, Marino B, Parretti di Iulio D, Guccione P, Carotti A, Formigari R, et al. Ventriculo-infundibular morphology in visceral heterotaxy with left isomerism. Giornale Ital Cardiol 1991;21:969-74.  Back to cited text no. 5
    

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Correspondence Address:
Bruno Marino
Department of Pediatric Cardiology, Policlinico Umberto I, Sapienza University of Rome
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/apc.APC_246_20

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