Single ventricle with normal relationship of the great vessels and pulmonic stenosis. A case report of an adult with the "Holmes heart"

Univentricular heart in adults: report of nine cases with review of the literature

Nine patients with univentricular heart 17 years of age or older were followed up for a mean duration of 13 years (range 5 to 26 years). Five patients had type A and four patients had type C univentricular heart. Pulmonary stenosis was present in eight of nine patients. Palliative shunt surgery was performed in seven patients, ventricular septation was performed in one patient, and no surgical intervention was performed in one patient. Eight patients were in New York Heart Association functional class II and one patient was in New York Heart Association functional class III. Long term follow-up of these patients suggests that a selected group of adults with univentricular heart may achieve a relatively long survival and good functional class with conservative management.

Primitive ventricle with normally related great vessels and stenotic subpulmonary outlet chamber. Angiographic differentiation from tetralogy of Fallot

Four patients with primitive ventricle and normally related great vessels with stenotic subpulmonary outlet chamber (Holmes' heart with pulmonary stenosis) are reported. The history, physical examination, and chest x-ray film are not helpful in distinguishing Holmes' heart with pulmonary stenosis from tetralogy of Fallot. Electrocardiogram often provides the first clue to the presence of Holmes' heart; left axis deviation with or without left ventricular hypertrophy is an unusual finding in tetralogy of Fallot, but common in Holmes' heart. Selective ventriculography is diagnostic: the right ventricular outflow chamber overlies the aortic root and aortic valve in the frontal view in Holmes' heart with pulmonary stenosis, but is to the left of the aortic valve in tetralogy of Fallot; no ventricular septum can be identified in Holmes' heart. The diagnosis can be suspected in a child with clinical features of tetralogy of Fallot but atypical electrocardiogram, and can be established by angiography.

Common (single) ventricle with normally related great vessels

A rare form of common ventricle with normally related great vessels and normal tricuspid and mitral valves should be considered in the differential diagnosis of cardiac anomalies presenting with cyanosis. Fourteen cases of this type of common ventricle were studied; in seven the diagnosis was made at necropsy and in seven it was based on angiographic evidence. That the common ventricle was morphologically a left ventricle was determined in the seven necropsy cases, and angiocardiographic examination confirmed the finding in the others. Continuity of the aortic valve and the mitral valve was observed in all the necropsy cases and in five of the clinical cases. Cyanosis had been observed clinically in 13 of the 14 cases, and pulmonary stenosis was present in four necropsy and three clinical cases. Electrocardiograms showed left axis deviation in nine of the 13 cases studied. Vectorcardiographic findings, though variable and available in only seven cases, tended to show a narrow horizontal plane QRS vector loop in patients with restricted pulmonary blood flow and a wide loop in those with increased pulmonary flow.

The clinical, laboratory, and pathologic findings are reported and the differential diagnosis and the profile of the condition are considered.