1
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Kelley BP, Glasco S, Sang CJ, Yoo B, Yeung M, Zhang J. To flip or not: Case series of coronary angioplasty in patients with right-sided heart. Catheter Cardiovasc Interv 2024; 103:565-569. [PMID: 38344889 DOI: 10.1002/ccd.30973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/13/2023] [Accepted: 02/03/2024] [Indexed: 03/19/2024]
Abstract
Coronary angioplasty in patients with a right-sided heart may be difficult due to challenges in engaging the coronary arteries, interpreting angiogram, and further delivering intracoronary therapies. We present our experience of percutaneous coronary intervention in two cases and propose a practical algorithm to approach cardiac catheterization in these patients.
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Affiliation(s)
- Brian P Kelley
- Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shanice Glasco
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Charlie J Sang
- Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Bianca Yoo
- Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michael Yeung
- Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jiandong Zhang
- Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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2
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Nabhan EM, Bechara T. Isolated Dextrocardia With Situs Solitus Diagnosed in a Centenarian Patient: A Case Report. Cureus 2023; 15:e42686. [PMID: 37649931 PMCID: PMC10464863 DOI: 10.7759/cureus.42686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/01/2023] Open
Abstract
This case report presents a rare instance of dextrocardia with situs solitus in a centenarian patient, where the heart is abnormally positioned on the right side of the chest due to embryological development anomalies. The patient, a 102-year-old male with no significant medical history, sought medical attention for cataract surgery and was incidentally found to have a systolic murmur over the left upper sternal border, prompting further evaluation. Echocardiographic assessments revealed moderate aortic stenosis. Further imaging with an upright chest X-ray confirmed the presence of dextrocardia with situs solitus. This intriguing case exemplifies the complexities of diagnosing rare congenital anomalies and underscores the importance of comprehensive evaluations even in elderly patients.
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Affiliation(s)
- Elias M Nabhan
- Internal Medicine, Lebanese University Faculty of Medicine, Beirut, LBN
- Cardiology, University of Balamand, Beirut, LBN
| | - Tony Bechara
- Cardiology, Central Military Hospital, Beirut, LBN
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3
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Revealing the Truth of Severe Right Axis Deviation Due to Large Hiatal Hernia. Am J Med 2022; 135:e376. [PMID: 36038225 DOI: 10.1016/j.amjmed.2022.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 11/23/2022]
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4
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Chaudhary RK, Larsen M, Nepal P, Songmen S, Gupta E, Sapire J. Bilateral subdiaphragmatic renal ectopia with associated congenital anomalies: a case report and systematic review of cases. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00887-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Cephalad renal ectopia is rare. Ectopic kidneys besides being prone to various pathologies are occasionally associated with other congenital abnormalities. To the best our knowledge, at the time of this writing, only ten cases of bilateral subdiaphragmatic renal ectopia had been reported.
Case presentation: We present a rare case of bilateral subdiaphragmatic ectopic kidneys incidentally discovered during evaluation of the abdominal pain. In addition, our patient had associated anomalies of the liver, spleen and mesocardia.
Conclusions
Recognition of this condition is important for accurate diagnosis, surgical and/or intervention planning, as well as identifying other associated anomalies.
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5
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Mikami BS, Hynd TE, Lee UY, DeMeo J, Thompson JD, Sokiranski R, Doll S, Lozanoff S. Extended reality visualization of medical museum specimens: Online presentation of conjoined twins curated by Dr. Jacob Henle between 1844-1852. TRANSLATIONAL RESEARCH IN ANATOMY 2022; 27. [PMID: 36133355 PMCID: PMC9489256 DOI: 10.1016/j.tria.2022.100171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: The purpose of this study is to characterize a full-term conjoined twins’ cadaver curated by Dr. Jacob Henle sometime between 1844 and 1852 and demonstrate digital distribution of an old and rare medical museum specimen using an extended reality (XR) model workflow. Methods: The cadaver (Preparation 296) is in the Department of Anatomy and Cell Biology at the University of Heidelberg. An XR display workflow comprises image capture, segmentation, and visualization using CT/MR scans derived from the cadaver. Online radiology presentation to medical students focuses on diagnostic characteristics of anatomical systems depicted with XR models. Results: Developmental defects in Preparation 296 include duplicated supradiaphragmatic structures and abnormal osteological features. Subdiaphragmatically, the gut is continuous on the right, but terminates at the distal esophagus on the left. One large liver occupies the abdomen with one spleen located on the left side. Observations suggest duplication of the primitive streak and separate notochords rostrally. Duplication occurs near the yolk sac and involves midgut formation while secondary midline fusion of the upper extremities and ribs likely results from the proximity of the embryos during development. Medical students access the model with device agnostic software during the curricular topic “Human Body Plan” that includes embryology concepts covering mechanisms of twinning. Conclusions: The workflow enables ease-of-access XR visualizations of an old and rare museum specimen. This study also demonstrates digital distribution and utilization of XR models applicable to embryology education.
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Hakimi M, Yabumoto M, Sun J, Rochon-Duck M, Donaldson D. Implantation of a Dual-chamber Pacemaker in a Patient with Dextrocardia, Situs Inversus, and Sick Sinus Syndrome. J Innov Card Rhythm Manag 2022; 13:4889-4893. [PMID: 35251758 PMCID: PMC8887932 DOI: 10.19102/icrm.2022.130201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/02/2021] [Indexed: 11/11/2022] Open
Abstract
Situs inversus with dextrocardia is a rare congenital anomaly that presents a unique challenge for the consultant electrophysiologist. Implantation of cardiac device in these patients may be challenging owing to their individual cardiac and vascular anatomy. Consequently, adverse procedural outcomes are more common in this group and an informed pre- and intraoperative approach is critical. In this article, we present the relevant patient findings and implications for the electrophysiologist, including operative approaches. We then examine them in the context of an actual case, having implanted an intracardiac permanent pacemaker with a right-sided approach via the conventional method in a patient with dextrocardia situs inversus who had undergone multiple surgeries for structural heart disease.
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Affiliation(s)
- Matthew Hakimi
- Department of Medicine, Division of Cardiology, University of California Irvine Medical Center, Orange, CA, USA
| | - Maya Yabumoto
- Department of Medicine, Division of Cardiology, University of California Irvine Medical Center, Orange, CA, USA
| | - Jack Sun
- Department of Cardiothoracic Surgery, University of California Irvine Medical Center, Orange, CA, USA
| | - Michael Rochon-Duck
- Department of Medicine, Division of Cardiology, University of California Irvine Medical Center, Orange, CA, USA
| | - David Donaldson
- Department of Medicine, Division of Cardiology, University of California Irvine Medical Center, Orange, CA, USA
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7
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Tian B, Ma C, Su JW, Luo J, Sun HX, Su J, Ning ZP. Left atrial appendage occlusion in a mirror-image dextrocardia: A case report and review of literature. World J Clin Cases 2022; 10:1357-1365. [PMID: 35211570 PMCID: PMC8855170 DOI: 10.12998/wjcc.v10.i4.1357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/05/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In mirror-image dextrocardia, the anterior-posterior position of the cardiac chambers and great vessels is maintained, but the left-right orientation of the abdominal organs is reversed. The abnormal anatomy of the heart poses surgical challenges and problems in dealing with surgical risk and monitoring complications. There are few reports on closure of the left atrial appendage (LAA) in dextrocardia and no reports on the application of enhanced recovery after surgery (ERAS) following LAA occlusion (LAAO) procedures.
CASE SUMMARY The objective for this case was to ensure perioperative safety and accelerate postoperative recovery from LAAO in a patient with mirror-image dextrocardia. ERAS was guided by the theory and practice of nursing care. Atrial fibrillation was diagnosed in a 77-year-old male patient, in whom LAAO was performed. The 2019 guidelines for perioperative care after cardiac surgery recommend that the clinical nursing procedures for patients with LAAO should be optimized to reduce the incidence of perioperative complications and ensure patient safety. Music therapy can be used throughout perioperative treatment and nursing to improve the anxiety symptoms of patients.
CONCLUSION The procedure was uneventful and proceeded without complications. Anxiety symptoms were improved.
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Affiliation(s)
- Bei Tian
- Zhoupu Hospital Shanghai University of Medicine & Health Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Chuang Ma
- Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Jin-Wen Su
- Zhoupu Hospital Shanghai University of Medicine & Health Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Jun Luo
- Zhoupu Hospital Shanghai University of Medicine & Health Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Hong-Xia Sun
- Zhoupu Hospital Shanghai University of Medicine & Health Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Jie Su
- Shache County People's Hospital, Kashgar 200437, Xinjiang Uygur Autonomous Region, China
| | - Zhong-Ping Ning
- Zhoupu Hospital Shanghai University of Medicine & Health Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
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8
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Ortega-Zhindón DB, Flores-Sarria IP, Minakata-Quiróga MA, Angulo-Cruzado ST, Romero-Montalvo LA, Cervantes-Salazar JL. [Isomorfismo cardiaco: Una perspectiva multidisciplinaria]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2021; 91:470-479. [PMID: 34491249 PMCID: PMC8641457 DOI: 10.24875/acm.20000567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/17/2021] [Indexed: 12/03/2022] Open
Abstract
Atrial isomerism describes complex anatomical findings with defects in the determination of lateralization; being a rare situation, with a prevalence of 1 in every 10.000 to 20.000 live births, with an incidence of up to 4% of all cardiac malformations. The diagnosis can be made in the neonatal age; however, clinical presentation is nonspecific. Depending on the spectrum of malformations, complex and invasive diagnostic tools may be required. Treatment is varied and can range from palliative surgery in view of univentricular physiology to total correction surgery for biventricular repair.
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Affiliation(s)
| | | | | | | | - Luis A. Romero-Montalvo
- Departamento de Cardiología Intervencionista en Cardiopatías Congénitas. Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
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9
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Aizawa Y, Ichiki T, Yoshizawa A, Monma Y, Nakayama T, Kato TS, Inami S, Fujimoto Y, Kawamura A. Successful Leadless Pacemaker Implantation in an Elderly Patient With Dextrocardia and Situs Inversus. Cureus 2021; 13:e17858. [PMID: 34527500 PMCID: PMC8432435 DOI: 10.7759/cureus.17858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 11/05/2022] Open
Abstract
Leadless pacemaker is indicated in patients with symptomatic bradycardia as an alternative therapy when transvenous pacemaker implantation is considered difficult or at high risk. The experience of implanting leadless pacemaker in patients with dextrocardia and situs inversus is limited. A 94-year-old male was transferred to our hospital due to advanced atrio-ventricular block with episode of syncope. Chest radiograph and computed tomography revealed dextrocardia with situs inversus. Emergency cardiac catheterization was performed and a temporary pacemaker was inserted, but the patient removed it due to delirium. So, a leadless pacemaker was implanted to him. Shorter time of bed-rest after the implantation and shorter hospital stay would be beneficial of implanting a leadless pacemaker. Precise anatomical evaluation would be important to perform implantation efficiently and safely.
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Affiliation(s)
- Yoshiyasu Aizawa
- Cardiology, International University of Health and Welfare Narita Hospital, Narita, JPN
| | - Tomoko Ichiki
- Cardiology, International University of Health and Welfare Narita Hospital, Narita, JPN
| | - Akihiro Yoshizawa
- Cardiology, International University of Health and Welfare Narita Hospital, Narita, JPN
| | - Yuto Monma
- Cardiology, International University of Health and Welfare Narita Hospital, Narita, JPN
| | - Takashi Nakayama
- Cardiology, International University of Health and Welfare Narita Hospital, Narita, JPN
| | - Tomoko S Kato
- Cardiology, International University of Health and Welfare Narita Hospital, Narita, JPN
| | - Shigenobu Inami
- Cardiology, International University of Health and Welfare Narita Hospital, Narita, JPN
| | - Yoshihide Fujimoto
- Cardiology, International University of Health and Welfare Narita Hospital, Narita, JPN
| | - Akio Kawamura
- Cardiology, International University of Health and Welfare Narita Hospital, Narita, JPN
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10
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Arnaud M, Le Gloan L, Andorin A, Solnon A, Gourraud JB, Lande G. Atrial flutter radiofrequency ablation in the setting of left isomerism and repaired single atrium: First case. HeartRhythm Case Rep 2021; 7:446-448. [PMID: 34307026 PMCID: PMC8283537 DOI: 10.1016/j.hrcr.2021.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Marine Arnaud
- L'institut du thorax, INSERM, CNRS, University of Nantes, Nantes, France.,L'institut du thorax, CHU Nantes, Nantes, France
| | | | | | - Aude Solnon
- L'institut du thorax, CHU Nantes, Nantes, France
| | - Jean-Baptiste Gourraud
- L'institut du thorax, INSERM, CNRS, University of Nantes, Nantes, France.,L'institut du thorax, CHU Nantes, Nantes, France
| | - Gilles Lande
- L'institut du thorax, CHU Nantes, Nantes, France
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11
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Yuan ZZ, Fan LL, Jiang ZC, Yang YF, Tan ZP. A Novel Nonsense MMP21 Variant Causes Dextrocardia and Congenital Heart Disease in a Han Chinese Patient. Front Cardiovasc Med 2020; 7:582350. [PMID: 33240936 PMCID: PMC7680847 DOI: 10.3389/fcvm.2020.582350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 10/12/2020] [Indexed: 12/18/2022] Open
Abstract
The position and morphology of human internal organs are asymmetrically distributed along the left-right axis. Aberrant left-right patterning in the developing embryo can lead to a series of congenital laterality defects, such as dextrocardia and heterotaxy syndrome. Laterality defects are a genetic condition; however, pathogenic genetic lesions are found in only one-fifth of patients. In this study, whole-exome sequencing was conducted for 78 patients with laterality defects. We identified a novel stopgain variant in MMP21 (c.G496T; p.G166*) in a Chinese patient with mirror-image dextrocardia. This variant caused a truncated MMP21 mRNA containing only the signal peptide and propeptide, while the coding sequence of matrix metalloproteinase-21 was almost entirely absent. To the best of our knowledge, this novel variant is the first homozygous stopgain variant identified in dextrocardia patients, and the first MMP21 variant found in East Asia. Our findings expand the spectrum of MMP21 variants and provide support for the critical role of MMP21 during left-right patterning in the Han Chinese population.
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Affiliation(s)
- Zhuang-Zhuang Yuan
- Clinical Center for Gene Diagnosis and Therapy, Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Cell Biology, School of Life Sciences, Central South University, Changsha, China.,Hunan Key Laboratory of Animal Models for Human Diseases, School of Life Sciences, Central South University, Changsha, China
| | - Liang-Liang Fan
- Department of Cell Biology, School of Life Sciences, Central South University, Changsha, China.,Hunan Key Laboratory of Animal Models for Human Diseases, School of Life Sciences, Central South University, Changsha, China
| | - Zi-Chen Jiang
- University of California, San Diego, San Diego, CA, United States
| | - Yi-Feng Yang
- Clinical Center for Gene Diagnosis and Therapy, Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhi-Ping Tan
- Clinical Center for Gene Diagnosis and Therapy, Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
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12
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Naaraayan A, Nimkar A, Acharya P, Pomerantz D, Jesmajian S. Dextrocardia: When right is wrong! J Atr Fibrillation 2020; 13:2222. [PMID: 34950286 DOI: 10.4022/jafib.2222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 08/26/2019] [Accepted: 09/29/2019] [Indexed: 11/10/2022]
Abstract
Introduction/Background Dextrocardia is a malposition of the heart in the thoracic cavity. Dextrocardia has been known to cause diagnostic dilemmas with atypical presentations in acute coronary syndrome, as well as technical challenges in patients who require interventions such as coronary catheterization, transcutaneous aortic valve replacement, ablation for arrhythmias, or pacemaker/defibrillator placement. Transcription factor Pitx2 has been shown to have a fundamental role during cardio-genesis, and its misexpression has been implicated in arrhythmogenesis and congenital heart diseases including visceral situs inversus. This association between congenital heart diseases and arrythmias is intriguing and need exploring. We aimed to quantify the likelihood of arrhythmias in patients with dextrocardia. Materials and Methods A descriptive, retrospective study was conducted on the National Inpatient Sample (NIS) databases for the year 2016. Patients with dextrocardia and arrhythmias were selected based on appropriate diagnostic codes. We used propensity score-matching to assemble a matched cohort in which adults with dextrocardia and controls balanced on measured baseline characteristics. This was done to reduce the confounding effect of between-group imbalances on outcomes. Complex survey design, weights, and clustering were accounted for during analysis. Multivariate regression analysis was performed to determine the relationship of arrhythmias and length of hospitalization with dextrocardia. Results The prevalence of arrhythmias in patients with dextrocardia was significantly higher than the control group. Overall, the odds of arrhythmia were higher for patients in the dextrocardia group when compared to a propensity matched control group [adjusted Odds ratio OR 2.60, Confidence Interval (CI) (1.67-4.06), p<0.001]. When looking at only principal/primary diagnosis on admission, the odds of an admitting diagnosis of arrhythmia were significantly higher in the dextrocardia group when compared to the matched cohort [adjusted OR 3.70, CI (1.26-10.89), p 0.02]. The increased odds of arrhythmia in dextrocardia patients were mostly accounted for by the increased odds of atrial fibrillation/atrial flutter [OR 3.06, CI (1.02-9.18), p 0.046] in these patients. No significant difference was found in the odds of other arrhythmias or the length of stay between the two groups. Conclusion In a large inpatient population, patients with dextrocardia were more likely to have arrhythmias especially atrial fibrillation/atrial flutter than patients without dextrocardia. Ours is the first study that investigates the clinical manifestations of molecular and embryologic associations between congenital heart disease and arrhythmias.
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Affiliation(s)
- Ashutossh Naaraayan
- Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, NY 10801
| | - Abhishek Nimkar
- Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, NY 10801
| | - Prakash Acharya
- Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, NY 10801
| | - Daniel Pomerantz
- Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, NY 10801
| | - Stephen Jesmajian
- Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, NY 10801
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13
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Kohli U, Hassan S. Dextrocardia and atrial fibrillation ablation: relevance of anatomy. J Interv Card Electrophysiol 2020; 60:155-157. [PMID: 32651868 DOI: 10.1007/s10840-020-00825-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/08/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Utkarsh Kohli
- Section of Pediatric Cardiology, Department of Pediatrics, Comer Children's Hospital and The University of Chicago Pritzker School of Medicine, 5841 S Maryland Ave., RM C104-E, MC 4051, Chicago, IL, 60637, USA.
| | - Sohail Hassan
- Division of Electrophysiology, Department of Cardiology, St. John Hospital and Medical Center, Detroit, MI, USA
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14
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Shen L, Zhao J, Yuan T, Li M, Cheng Y. A case report of late-onset symptoms of erythrocytosis in univentricular dextrocardia. Medicine (Baltimore) 2020; 99:e21092. [PMID: 32629741 PMCID: PMC7337453 DOI: 10.1097/md.0000000000021092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Univentricular dextrocardia is a rare congenital heart disease that usually presents cyanotic manifestations from childhood. Due to the sustained dysfunction of blood oxygenation, it is very difficult to keep an asymptomatic survival. Herein, we described an interesting case of univentricular dextrocardia who suffered from initial symptoms in his middle age. PATIENT CONCERNS A 54-year-old male patient with numbness and tingling of limbs was admitted to hospital due to the secondary manifestations of congenital heart disease. DIAGNOSIS The patient was diagnosed as univentricular dextrocardia with pulmonary hypertension and secondary erythrocytosis based on computed tomography (CT) scan, echocardiography, and laboratory examinations. INTERVENTIONS Intravenous hydration therapy with normal saline successfully eliminated his hyperviscosity associated symptoms. In view of socio-economic reasons, this patient refused surgical evaluation and further medical interventions. OUTCOMES During 18-month follow up, he received no drug except for regular water intake. Fortunately, his life quality was satisfactory, and no other symptoms emerged except for mild numbness of limbs. LESSONS In univentricular dextrocardia, it is possible to keep a long-term asymptomatic period due to the slow progress of pathophysiology. In this population, regular cardiac function evaluation and avoiding dehydration may help improve the quality of life.
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Affiliation(s)
- Lishui Shen
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | | | | | | | - Yun Cheng
- Department of Ultrasound, Zhejiang Hospital, Hangzhou, China
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15
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Lárez V, Mantilla Zambrano JM, Santis García EA, Olaya Rodríguez H, Acosta Peláez JD, Sánchez Cantillo JDJ, López Fernández AF. Revascularización miocárdica completa con injertos arteriales en un paciente con dextrocardia. REPERTORIO DE MEDICINA Y CIRUGÍA 2020. [DOI: 10.31260/repertmedcir.01217372.978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
La dextrocardia es una rara anomalía cardiaca congénita. Aunque la incidencia de enfermedad coronaria es similar a la población en general, son pocos los casos documentados en la literatura. La disposición anatómica en esta anomalía constituye un desafío a la hora de planificar la técnica quirúrgica y los injertos a utilizar. Presentamos el caso de un paciente de 59 años con enfermedad coronaria de 2 vasos que fue sometido a una cirugía de revascularización arterial completa.
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16
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Qutbi M. SPECT myocardial perfusion imaging in patients with Dextrocardia. J Nucl Cardiol 2019; 26:1197-1204. [PMID: 31062220 DOI: 10.1007/s12350-019-01732-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 04/15/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Mohsen Qutbi
- Department of Nuclear Medicine, Taleghani Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Yaman St., Velenjak, Tehran, Iran.
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17
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Agarwal P, Agarwal RK. Left atrial isomerism associated with aneurysmal enlargement of right atrial appendage: A case report with literature review. Indian J Radiol Imaging 2019; 29:318-323. [PMID: 31741603 PMCID: PMC6857260 DOI: 10.4103/ijri.ijri_341_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/07/2019] [Accepted: 09/10/2019] [Indexed: 11/21/2022] Open
Abstract
We present a prenatally diagnosed case of heterotaxy syndrome (HS) in which left atrial isomerism (LAI) was associated with an aneurysmal enlargement of the right atrial appendage (RAA). Although LAI is usually associated with complex cardiac and extracardiac anomalies, the association of LAI and right atrial appendage aneurysm (RAAA) is exceptional. Congenital RAAA itself is an idiopathic, very rare cardiac anomaly characterized by the enlargement of the appendage in the absence of any other cardiac or extra-cardiac defect. The prognosis of the heterotaxy is poor with associated major cardiac malformations and even cases with minor cardiac anomalies are at risk postnatally for complications like biliary atresia, intestinal rotational abnormalities, and immune disorders. In this case, the prenatal diagnosis of the isomerism was mainly based on the abnormalities of caval veins. Although no typical complex cardiac anomaly was present, the HS was associated with biliary atresia, polysplenia, and malrotation of the gut. Associated RAAA further imposed an additional risk of complications such as tachyarrhythmias, thromboembolic events, and aneurysmal rupture.
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Affiliation(s)
- Prateek Agarwal
- Department of Radiodiagnosis, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka
| | - Rajesh Kumar Agarwal
- Department of Ultrasound, Meera Hospital, Shiv Marg, Bani Park, Jaipur, Rajasthan, India
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18
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Zhang W, Li D, Wei S, Guo T, Wang J, Luo H, Yang Y, Tan Z. Whole-exome sequencing identifies a novel CCDC151 mutation, c.325G>T (p.E109X), in a patient with primary ciliary dyskinesia and situs inversus. J Hum Genet 2018; 64:249-252. [DOI: 10.1038/s10038-018-0540-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 10/18/2018] [Accepted: 11/04/2018] [Indexed: 01/10/2023]
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19
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Ta-Shma A, Hjeij R, Perles Z, Dougherty GW, Abu Zahira I, Letteboer SJF, Antony D, Darwish A, Mans DA, Spittler S, Edelbusch C, Cindrić S, Nöthe-Menchen T, Olbrich H, Stuhlmann F, Aprea I, Pennekamp P, Loges NT, Breuer O, Shaag A, Rein AJJT, Gulec EY, Gezdirici A, Abitbul R, Elias N, Amirav I, Schmidts M, Roepman R, Elpeleg O, Omran H. Homozygous loss-of-function mutations in MNS1 cause laterality defects and likely male infertility. PLoS Genet 2018; 14:e1007602. [PMID: 30148830 PMCID: PMC6128653 DOI: 10.1371/journal.pgen.1007602] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 09/07/2018] [Accepted: 08/02/2018] [Indexed: 12/22/2022] Open
Abstract
The clinical spectrum of ciliopathies affecting motile cilia spans impaired mucociliary clearance in the respiratory system, laterality defects including heart malformations, infertility and hydrocephalus. Using linkage analysis and whole exome sequencing, we identified two recessive loss-of-function MNS1 mutations in five individuals from four consanguineous families: 1) a homozygous nonsense mutation p.Arg242* in four males with laterality defects and infertility and 2) a homozygous nonsense mutation p.Gln203* in one female with laterality defects and recurrent respiratory infections additionally carrying homozygous mutations in DNAH5. Consistent with the laterality defects observed in these individuals, we found Mns1 to be expressed in mouse embryonic ventral node. Immunofluorescence analysis further revealed that MNS1 localizes to the axonemes of respiratory cilia as well as sperm flagella in human. In-depth ultrastructural analyses confirmed a subtle outer dynein arm (ODA) defect in the axonemes of respiratory epithelial cells resembling findings reported in Mns1-deficient mice. Ultrastructural analyses in the female carrying combined mutations in MNS1 and DNAH5 indicated a role for MNS1 in the process of ODA docking (ODA-DC) in the distal respiratory axonemes. Furthermore, co-immunoprecipitation and yeast two hybrid analyses demonstrated that MNS1 dimerizes and interacts with the ODA docking complex component CCDC114. Overall, we demonstrate that MNS1 deficiency in humans causes laterality defects (situs inversus) and likely male infertility and that MNS1 plays a role in the ODA-DC assembly.
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Affiliation(s)
- Asaf Ta-Shma
- Department of Pediatric Cardiology, Hadassah, Hebrew University Medical Center, Jerusalem, Israel
- Monique and Jacques Roboh Department of Genetic Research, Hadassah, Hebrew University Medical Center, Jerusalem, Israel
| | - Rim Hjeij
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Zeev Perles
- Department of Pediatric Cardiology, Hadassah, Hebrew University Medical Center, Jerusalem, Israel
| | - Gerard W. Dougherty
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Ibrahim Abu Zahira
- Department of Pediatric Cardiology, Hadassah, Hebrew University Medical Center, Jerusalem, Israel
| | - Stef J. F. Letteboer
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
- Radboud Institute for Molecular Life Sciences, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Dinu Antony
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
- Radboud Institute for Molecular Life Sciences, Radboud University Nijmegen, Nijmegen, the Netherlands
- Pediatric Genetics Division, Center for Pediatrics and Adolescent Medicine, Faculty of Medicine, Freiburg University, Freiburg, Germany
| | - Alaa Darwish
- Department of Pediatric Cardiology, Hadassah, Hebrew University Medical Center, Jerusalem, Israel
| | - Dorus A. Mans
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
- Radboud Institute for Molecular Life Sciences, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Sabrina Spittler
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Christine Edelbusch
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Sandra Cindrić
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Tabea Nöthe-Menchen
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Heike Olbrich
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Friederike Stuhlmann
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Isabella Aprea
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Petra Pennekamp
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Niki T. Loges
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Oded Breuer
- Pediatric Pulmonology Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Avraham Shaag
- Monique and Jacques Roboh Department of Genetic Research, Hadassah, Hebrew University Medical Center, Jerusalem, Israel
| | - Azaria J. J. T. Rein
- Department of Pediatric Cardiology, Hadassah, Hebrew University Medical Center, Jerusalem, Israel
| | - Elif Yilmaz Gulec
- University of Health Sciences, Kanuni Sultan Suleyman, Training and Research Hospital, Department of Medical Genetics, Istanbul, Turkey
| | - Alper Gezdirici
- University of Health Sciences, Kanuni Sultan Suleyman, Training and Research Hospital, Department of Medical Genetics, Istanbul, Turkey
| | - Revital Abitbul
- Pediatric Department, Ziv Medical Center, Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Nael Elias
- Saint Vincent Hospital, Nazareth, Faculty of Medicine, Bar Ilan University, Israel
| | - Israel Amirav
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Pediatric Pulmonology Unit, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Miriam Schmidts
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
- Radboud Institute for Molecular Life Sciences, Radboud University Nijmegen, Nijmegen, the Netherlands
- Pediatric Genetics Division, Center for Pediatrics and Adolescent Medicine, Faculty of Medicine, Freiburg University, Freiburg, Germany
| | - Ronald Roepman
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
- Radboud Institute for Molecular Life Sciences, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Orly Elpeleg
- Monique and Jacques Roboh Department of Genetic Research, Hadassah, Hebrew University Medical Center, Jerusalem, Israel
| | - Heymut Omran
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
- * E-mail:
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Long W, He Z, Wang X, Wu H, Chen Y, Yang Z. Successful Drug-eluting Stent Implantation in a Male Patient with Dextrocardia: A Case Report. Open Med (Wars) 2018; 12:481-484. [PMID: 29340305 PMCID: PMC5767705 DOI: 10.1515/med-2017-0067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 11/29/2017] [Indexed: 11/15/2022] Open
Abstract
Situs inversus with dextrocardia is a rare condition, with complete transposition of all the body organs, including the heart. Percutaneous coronary intervention (PCI) in these patients is technically difficult because of the mirror image of organs. Here, we describe a 56-year-old man with coronary heart disease with known situs inversus with dextrocardia and coronary percutaneous intervention was performed for stenosis in the right coronary artery. A drug eluting stent was implanted at this site successfully. This case suggested that the interventional management of such patients follows the same general rules as for non-dextrocardia patients, but the manipulation of the catheter and projection position choices need to be taken into consideration to obtain optimal benefits for the patient.
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Affiliation(s)
- Wenjie Long
- No. 1 Clinical College, Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Jichang road No.12, Guangzhou, Guangdong 510000, China
| | - Zhiling He
- Department of Cardiology, Guangdong Provincial Hospital of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510000, China
| | - Xia Wang
- Department of Cardiology, Guangdong Provincial Hospital of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510000, China
| | - Huanlin Wu
- Department of Cardiology, Guangdong Provincial Hospital of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510000, China
| | - Yahui Chen
- Department of Cardiology, Guangdong Provincial Hospital of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510000, China
| | - Zhongqi Yang
- Department of Geriatrics, Lingnan Medical Research Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road No.16, Guangzhou, Guangdong 510000, China
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Wang X, Shi Y, Zeng S, Zhou J, Zhou J, Yuan H, Wang L, Shi W, Zhou Q. Comparing levocardia and dextrocardia in fetuses with heterotaxy syndrome: prenatal features, clinical significance and outcomes. BMC Pregnancy Childbirth 2017; 17:393. [PMID: 29169330 PMCID: PMC5701355 DOI: 10.1186/s12884-017-1579-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/15/2017] [Indexed: 01/01/2023] Open
Abstract
Background To investigate the differences in cardiovascular disease, extracardiac anomalies and outcomes between fetuses with levocardia and dextrocardia. Methods Clinical demographics, prenatal features, postnatal characteristics and the outcomes of fetuses with levocardia or dextrocardia were recorded and analyzed. Results Sixty-five fetuses with dextrocardia and thirty-eight fetuses with levocardia were enrolled. Right ventricle outlet obstruction, atrioventricular septal defect and intestinal malrotation were common in both groups. Univentricular physiology, transposition of the great arteries and esophageal atresia were more frequent in fetuses with levocardia, whereas abnormal pulmonary venous connection, double outlet of right ventricle, left ventricle outlet obstruction and brain abnormalities were more frequent in the dextrocardia group. The accuracy of evaluating cardiac malformations was high, but the sensitivity in assessing extracardiac abnormalities was low. Conclusions Although the disorders have certain overlapping features, there are several differences between fetuses with levocardia and dextrocardia. These findings might improve patient counseling and perinatal management.
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Affiliation(s)
- Xiaofang Wang
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, 139 Renmin Road (M), Changsha, Hunan, 410011, China
| | - Yifan Shi
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, 139 Renmin Road (M), Changsha, Hunan, 410011, China.,Department of Ultrasonography, Chenzhou No.1 People's hospital, Chenzhou, Hunan, 423000, China
| | - Shi Zeng
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, 139 Renmin Road (M), Changsha, Hunan, 410011, China
| | - Jiawei Zhou
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, 139 Renmin Road (M), Changsha, Hunan, 410011, China
| | - Jia Zhou
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, 139 Renmin Road (M), Changsha, Hunan, 410011, China.,Department of Ultrasonography, The first affiliated hospital of University of South China, Hengyang, Hunan, 421001, China
| | - Hongxia Yuan
- Department of Ultrasonography, Maternal & Child Health Center of Changsha, Changsha, Hunan, 410011, China
| | - Lin Wang
- Department of Ultrasonography, Maternal & Child Health Center of Zhuzhou, Zhuzhou, Hunan, 412000, China
| | - Weiyuan Shi
- Department of Ultrasonography, Chenzhou No.1 People's hospital, Chenzhou, Hunan, 423000, China
| | - Qichang Zhou
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, 139 Renmin Road (M), Changsha, Hunan, 410011, China.
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Kintis K, Patsilinakos S, Koutouzis M, Kasiakogias A, Nikolaou N, Andrikou I, Tsioufis C. Successful left transradial coronary angiography in an elderly patient with dextrocardia and severe aortic stenosis. Hellenic J Cardiol 2017; 58:436-438. [PMID: 28529182 DOI: 10.1016/j.hjc.2017.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 05/03/2017] [Accepted: 05/11/2017] [Indexed: 11/18/2022] Open
Affiliation(s)
| | | | - Michael Koutouzis
- Second Cardiology Department, Red Cross General Hospital, Athens, Greece
| | | | - Nikolaos Nikolaou
- Department of Cardiology, Konstantopoulio General Hospital, Athens, Greece
| | - Ioannis Andrikou
- First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece
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23
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Repair of oesophageal atresia with tracheo-oesophageal fistula associated with dextrocardia through right-sided thoracotomy approach. ANNALS OF PEDIATRIC SURGERY 2016. [DOI: 10.1097/01.xps.0000482858.77300.4d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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24
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An atrial flutter in a 40-year-old woman with situs inversus, transposition of the great arteries, atrial switch, and interruption of the inferior vena cava. HeartRhythm Case Rep 2015; 2:159-163. [PMID: 28491658 PMCID: PMC5412612 DOI: 10.1016/j.hrcr.2015.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Offen S, Jackson D, Canniffe C, Choudhary P, Celermajer DS. Dextrocardia in Adults with Congenital Heart Disease. Heart Lung Circ 2015; 25:352-7. [PMID: 26541676 DOI: 10.1016/j.hlc.2015.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 08/28/2015] [Accepted: 09/05/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND/OBJECTIVES Dextrocardia is rare in the general population, and may be associated with significant additional cardiac malformations. We aimed to identify the prevalence and patterns of additional cardiac defects, as well as the associated long-term morbidity and mortality, in adult patients with dextrocardia, in a specialised Adult Congenital Heart Disease (ACHD) service. METHODS A retrospective study of patients with dextrocardia managed by our tertiary ACHD service, since January 2000, was performed. Medical records were reviewed and the National Death Index was consulted to confirm survival status. RESULTS Of 3698 adults in our ACHD Service, 19 (0.5%) had dextrocardia. Mean follow-up duration was 7±7.5 years. The mean age at last review was 36.8±10.5 years (range 20-63 years). Situs was solitus in 14 (74%) and inversus in five (26%). Eleven patients (58%) had functional single ventricles, of whom five had atrioventricular (AV)-ventriculoarterial (VA) discordance and two had VA discordance only. Four patients with two ventricles had AV-VA discordance. All patients had at least one additional cardiac malformation. Fourteen patients (74%) required surgical intervention. Eleven patients (58%) underwent a Fontan-type operation. Five patients (26%) required ablation procedures for arrhythmia. One patient had infective endocarditis and two deaths occurred, both in patients who also had AV-VA discordance. CONCLUSION Dextrocardia remains a rare finding in adults, even in a highly select group of patients with known congenital heart disease. Those with associated congenital heart abnormalities are likely to have complex lesions, which may require multiple surgical and medical interventions. Despite this, our series demonstrated that patients surviving to adulthood and then managed in an ACHD centre may have good medium-term survival.
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Affiliation(s)
- Sophie Offen
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia
| | - Dan Jackson
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Carla Canniffe
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Preeti Choudhary
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia
| | - David S Celermajer
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia.
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26
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Mori M, Shuto K, Hirano A, Kosugi C, Tanaka K, Koda K. Laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor with complete situs inversus: report of a case. Surg Case Rep 2015; 1:72. [PMID: 26366368 PMCID: PMC4560153 DOI: 10.1186/s40792-015-0076-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 08/25/2015] [Indexed: 02/05/2023] Open
Abstract
We herein report our experience of performing laparoscopic and endoscopic cooperative surgery for a gastrointestinal stromal tumor with complete situs inversus. A 78-year-old man was referred to our department for treatment of a gastric submucosal tumor. Based on chest X-ray and computed tomography (CT) findings, complete situs inversus was also diagnosed. Upper gastrointestinal endoscopy and imaging showed a 45-mm gastric submucosal tumor in the upper stomach near the esophagogastric junction. We performed local resection of the gastric submucosal tumor by laparoscopic and endoscopic cooperative surgery. Pathological examination revealed that the tumor was an intermediate-risk gastrointestinal stromal tumor, and the patient was discharged on postoperative day 12. The patient is still alive without recurrence or any complications 9 months after surgery.
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Affiliation(s)
- Mikito Mori
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, 299-0111 Japan
| | - Kiyohiko Shuto
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, 299-0111 Japan
| | - Atsushi Hirano
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, 299-0111 Japan
| | - Chihiro Kosugi
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, 299-0111 Japan
| | - Kuniya Tanaka
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, 299-0111 Japan
| | - Keiji Koda
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, 299-0111 Japan
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27
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Lopez MM, Kuzma AB, Margiocco ML, Cheng T, Enberg TB, Head L. Cardiac malposition (ectopia cordis) in a cat. J Vet Emerg Crit Care (San Antonio) 2015; 25:783-8. [PMID: 26193979 DOI: 10.1111/vec.12342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 11/01/2013] [Accepted: 05/20/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe a case of cardiac malposition in a cat, and the successful management of the anomaly. CASE DESCRIPTION A 2-year-old male neutered male British Shorthair cat weighing 7.58 kg was referred for bicavitary effusion. Ultrasonography and echocardiography demonstrated displacement of the heart into the abdomen through a diaphragmatic defect. Clinical signs of right-sided congestive heart failure were attributed to mechanical restriction of diastolic function by a constrictive segment of fibrous pericardium and to impaired venous return due to a kink in the caudal vena cava. Surgical repositioning of the heart into the thoracic cavity and a subtotal pericardectomy were performed, and the diaphragmatic defect was repaired. The patient recovered well postoperatively. NEW OR UNIQUE INFORMATION PROVIDED The diagnosis and management of cardiac malposition has not been previously described in cats. With timely diagnosis and surgical intervention, a favorable outcome is possible.
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Affiliation(s)
- Melinda M Lopez
- Canada West Veterinary Specialists, 1988 Kootenay Street, Vancouver, British Columbia, V5M 4Y3, Canada
| | - Alan B Kuzma
- Canada West Veterinary Specialists, 1988 Kootenay Street, Vancouver, British Columbia, V5M 4Y3, Canada
| | - Marco L Margiocco
- Canada West Veterinary Specialists, 1988 Kootenay Street, Vancouver, British Columbia, V5M 4Y3, Canada
| | - Teresa Cheng
- Canada West Veterinary Specialists, 1988 Kootenay Street, Vancouver, British Columbia, V5M 4Y3, Canada
| | - Trevor B Enberg
- Canada West Veterinary Specialists, 1988 Kootenay Street, Vancouver, British Columbia, V5M 4Y3, Canada
| | - Laurie Head
- Canada West Veterinary Specialists, 1988 Kootenay Street, Vancouver, British Columbia, V5M 4Y3, Canada
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Perioperative implications and management of dextrocardia. J Anesth 2015; 29:769-85. [DOI: 10.1007/s00540-015-2019-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 04/14/2015] [Indexed: 12/27/2022]
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29
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Narasimhan V, Hjeij R, Vij S, Loges NT, Wallmeier J, Koerner-Rettberg C, Werner C, Thamilselvam SK, Boey A, Choksi SP, Pennekamp P, Roy S, Omran H. Mutations in CCDC11
, which Encodes a Coiled-Coil Containing Ciliary Protein, Causes Situs Inversus
Due to Dysmotility of Monocilia in the Left-Right Organizer. Hum Mutat 2015; 36:307-18. [DOI: 10.1002/humu.22738] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 11/20/2014] [Indexed: 11/07/2022]
Affiliation(s)
| | - Rim Hjeij
- Department of Pediatrics; University Hospital Muenster; Albert Schweitzer Campus 1 Muenster Germany
| | - Shubha Vij
- Genes; Development and Disease Laboratory; Institute of Molecular and Cell Biology; Proteos Singapore
| | - Niki Tomas Loges
- Department of Pediatrics; University Hospital Muenster; Albert Schweitzer Campus 1 Muenster Germany
| | - Julia Wallmeier
- Department of Pediatrics; University Hospital Muenster; Albert Schweitzer Campus 1 Muenster Germany
| | - Cordula Koerner-Rettberg
- Klinik für Kinder-und Jugendmedizin im St. Josef-Hospital; Ruhr-Universität Bochum; Bochum Germany
| | - Claudius Werner
- Department of Pediatrics; University Hospital Muenster; Albert Schweitzer Campus 1 Muenster Germany
| | - Surin Kumar Thamilselvam
- Genes; Development and Disease Laboratory; Institute of Molecular and Cell Biology; Proteos Singapore
| | - Adrian Boey
- Institute of Medical Biology - Institute of Molecular and Cell Biology Joint Electron Microscopy Suite; Singapore
| | - Semil P. Choksi
- Genes; Development and Disease Laboratory; Institute of Molecular and Cell Biology; Proteos Singapore
| | - Petra Pennekamp
- Department of Pediatrics; University Hospital Muenster; Albert Schweitzer Campus 1 Muenster Germany
| | - Sudipto Roy
- Genes; Development and Disease Laboratory; Institute of Molecular and Cell Biology; Proteos Singapore
- Department of Biological Sciences; National University of Singapore; Singapore
- Department of Paediatrics; Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - Heymut Omran
- Department of Pediatrics; University Hospital Muenster; Albert Schweitzer Campus 1 Muenster Germany
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Blum M, Schweickert A, Vick P, Wright CVE, Danilchik MV. Symmetry breakage in the vertebrate embryo: when does it happen and how does it work? Dev Biol 2014; 393:109-23. [PMID: 24972089 PMCID: PMC4481729 DOI: 10.1016/j.ydbio.2014.06.014] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 06/08/2014] [Accepted: 06/17/2014] [Indexed: 10/25/2022]
Abstract
Asymmetric development of the vertebrate embryo has fascinated embryologists for over a century. Much has been learned since the asymmetric Nodal signaling cascade in the left lateral plate mesoderm was detected, and began to be unraveled over the past decade or two. When and how symmetry is initially broken, however, has remained a matter of debate. Two essentially mutually exclusive models prevail. Cilia-driven leftward flow of extracellular fluids occurs in mammalian, fish and amphibian embryos. A great deal of experimental evidence indicates that this flow is indeed required for symmetry breaking. An alternative model has argued, however, that flow simply acts as an amplification step for early asymmetric cues generated by ion flux during the first cleavage divisions. In this review we critically evaluate the experimental basis of both models. Although a number of open questions persist, the available evidence is best compatible with flow-based symmetry breakage as the archetypical mode of symmetry breakage.
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Affiliation(s)
- Martin Blum
- University of Hohenheim, Institute of Zoology (220), Garbenstrasse 30, D-70593 Stuttgart, Germany.
| | - Axel Schweickert
- University of Hohenheim, Institute of Zoology (220), Garbenstrasse 30, D-70593 Stuttgart, Germany
| | - Philipp Vick
- University of Hohenheim, Institute of Zoology (220), Garbenstrasse 30, D-70593 Stuttgart, Germany
| | - Christopher V E Wright
- Department of Cell and Developmental Biology, Vanderbilt University, Nashville, TN 37232-0494, USA
| | - Michael V Danilchik
- Department of Integrative Biosciences, Oregon Health & Science University, Portland, OR 97239-3098, USA
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Oztunc F, Madazli R, Yuksel MA, Gökalp S, Oncul M. Diagnosis and outcome of pregnancies with prenatally diagnosed fetal dextrocardia. J Matern Fetal Neonatal Med 2014; 28:1104-7. [PMID: 25007986 DOI: 10.3109/14767058.2014.943659] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the incidence, associated cardiac and extracardiac malformations and clinical outcome of fetuses with dextrocardia. METHOD A retrospective review of 3556 fetal echocardiograms between 2000 and 2011 revealed 39 cases of dextrocardia. Dextrocardia was defined as right-sided positioning of the fetal heart. Prenatal and postnatal records of the fetuses were reviewed. RESULTS The incidence was 1.1%. Of the 39 fetuses, 22 were primary dextrocardia and 17 were dextroposition. Diaphragmatic hernia was the most common cause of dextroposition with the incidence of 76%. Of the fetuses with dextroposition 35.5% had a cardiac anomaly. The survival rate of dextroposition was 31.2% and none of the survivors had an associated cardiac anomaly. Primary fetal dextrocardia was most common with situs solitus (45.4%), followed by situs ambiguous (36.3%) and then situs inversus totalis (18.1%). Structural cardiac malformations were found in 100%, 80% and 25% of fetuses with situs ambiguous, solitus and inversus, respectively. Of the dextroposition, 47.6% terminated pregnancy, 14.2% resulted in intrauterine death, 9.5% died after birth, and 28.5% survived. CONCLUSION A wide spectrum of complex cardiac malformations are associated with fetal dextrocardia. Fetal echocardiography enables detection of complex cardiac anomalies so that parents can be appropriately counselled.
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Romaguera R, Roura G, Gómez-Hospital JA, Gómez-Lara J, Moris C, Cequier A. CoreValve® aortic bioprosthesis implantation in a patient with situs inversus totalis with dextrocardia. ACTA ACUST UNITED AC 2014; 66:409-10. [PMID: 24775829 DOI: 10.1016/j.rec.2012.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 10/24/2012] [Indexed: 11/18/2022]
Affiliation(s)
- Rafael Romaguera
- Departamento de Cardiología Intervencionista, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Gerard Roura
- Departamento de Cardiología Intervencionista, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Joan A Gómez-Hospital
- Departamento de Cardiología Intervencionista, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Gómez-Lara
- Departamento de Cardiología Intervencionista, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - César Moris
- Departamento de Cardiología Intervencionista, Hospital Central de Asturias, Oviedo, Asturias, Spain
| | - Angel Cequier
- Departamento de Cardiología Intervencionista, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
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Wolla CD, Hlavacek AM, Schoepf UJ, Bucher AM, Chowdhury S. Cardiovascular manifestations of heterotaxy and related situs abnormalities assessed with CT angiography. J Cardiovasc Comput Tomogr 2013; 7:408-16. [PMID: 24331937 DOI: 10.1016/j.jcct.2013.11.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 10/21/2013] [Accepted: 11/04/2013] [Indexed: 12/16/2022]
Abstract
Heterotaxy and situs abnormalities describe an abnormal arrangement of visceral organs in the thoracoabdominal cavity across the normal left-right axis of the body. It is associated with a high occurrence of congenital heart and abdominal defects, including anomalous pulmonary venous connections, systemic venous abnormalities, asplenia, and intestinal malrotation. Without proper diagnosis and surgical intervention, the prognosis of patients with heterotaxy syndrome and associated congenital defects is extremely poor. Complex intracardiac and extracardiac lesions are common in heterotaxy and can be difficult to assess by echocardiography. CT angiography (CTA) is a useful tool in this setting to accurately assess intracardiac and extracardiac abnormalities in this population for medical or surgical management. The intention of this pictorial essay is to review the most common cardiovascular defects involved with heterotaxy syndrome in addition to emphasizing the utility of CTA in the identification and classification of anomalies seen in these patients. This review briefly defines most common terminology used in situs abnormalities as well as presents CT images and 3-dimensional reconstructions of common anomalies associated with situs abnormalities. In summary, this review should prepare radiologists and pediatric cardiologists to describe heterotaxy and situs abnormalities in addition to recognizing the utility of CTA in these patients.
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Affiliation(s)
- Christopher D Wolla
- Department of Radiology and Radiological Science, Medical University of South, Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Anthony M Hlavacek
- Department of Radiology and Radiological Science, Medical University of South, Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425, USA; Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South, Carolina, Charleston, SC, USA
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South, Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425, USA; Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Andreas M Bucher
- Department of Radiology and Radiological Science, Medical University of South, Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425, USA; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Frankfurt, Germany
| | - Shahryar Chowdhury
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South, Carolina, Charleston, SC, USA
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Sparrow DB, Faqeih EA, Sallout B, Alswaid A, Ababneh F, Al-Sayed M, Rukban H, Eyaid WM, Kageyama R, Ellard S, Turnpenny PD, Dunwoodie SL. Mutation of HES7
in a large extended family with spondylocostal dysostosis and dextrocardia with situs inversus. Am J Med Genet A 2013; 161A:2244-9. [DOI: 10.1002/ajmg.a.36073] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 05/03/2013] [Indexed: 01/07/2023]
Affiliation(s)
- Duncan B. Sparrow
- Developmental and Stem Cell Biology Division; Victor Chang Cardiac Research Institute; Sydney Australia
- St. Vincent's Clinical School, Faculty of Medicine; UNSW; Sydney Australia
| | - Eissa Ali Faqeih
- Section of Medical Genetics, Department of Pediatrics; Children's Hospital, King Fahad Medical City; Riyadh, Kingdom of Saudi Arabia
| | - Bahauddin Sallout
- Women's Specialist Hospital, Maternal Fetal Department, King Fahad Medical City; Riyadh, Kingdom of Saudi Arabia
| | - Abdulrahman Alswaid
- Section of Medical Genetics, Department of Pediatrics; King Abdulaziz Medical City; Riyadh, Kingdom of Saudi Arabia
| | - Faroug Ababneh
- Section of Medical Genetics, Department of Pediatrics; King Abdulaziz Medical City; Riyadh, Kingdom of Saudi Arabia
| | - Moeenaldeen Al-Sayed
- Department of Medical Genetics; King Faisal Specialist Hospital & Research Centre; Riyadh, Kingdom of Saudi Arabia
| | - Hadeel Rukban
- Department of Pediatrics; King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Science; Riyadh, Kingdom of Saudi Arabia
| | - Wafaa M. Eyaid
- Department of Pediatrics; King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Science; Riyadh, Kingdom of Saudi Arabia
| | | | - Sian Ellard
- Molecular Genetics Laboratory; Royal Devon and Exeter Hospital; Exeter UK
| | - Peter D. Turnpenny
- Clinical Genetics Department; Royal Devon and Exeter Hospital; Exeter UK
| | - Sally L. Dunwoodie
- Developmental and Stem Cell Biology Division; Victor Chang Cardiac Research Institute; Sydney Australia
- St. Vincent's Clinical School, Faculty of Medicine; UNSW; Sydney Australia
- School of Biotechnology and Biomolecular Sciences, Faculty of Science; UNSW; Sydney Australia
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Vandenberg LN, Levin M. A unified model for left-right asymmetry? Comparison and synthesis of molecular models of embryonic laterality. Dev Biol 2013; 379:1-15. [PMID: 23583583 PMCID: PMC3698617 DOI: 10.1016/j.ydbio.2013.03.021] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 03/15/2013] [Accepted: 03/22/2013] [Indexed: 12/31/2022]
Abstract
Understanding how and when the left-right (LR) axis is first established is a fundamental question in developmental biology. A popular model is that the LR axis is established relatively late in embryogenesis, due to the movement of motile cilia and the resultant directed fluid flow during late gastrulation/early neurulation. Yet, a large body of evidence suggests that biophysical, molecular, and bioelectrical asymmetries exist much earlier in development, some as early as the first cell cleavage after fertilization. Alternative models of LR asymmetry have been proposed that accommodate these data, postulating that asymmetry is established due to a chiral cytoskeleton and/or the asymmetric segregation of chromatids. There are some similarities, and many differences, in how these various models postulate the origin and timing of symmetry breaking and amplification, and these events' linkage to the well-conserved subsequent asymmetric transcriptional cascades. This review examines experimental data that lend strong support to an early origin of LR asymmetry, yet are also consistent with later roles for cilia in the amplification of LR pathways. In this way, we propose that the various models of asymmetry can be unified: early events are needed to initiate LR asymmetry, and later events could be utilized by some species to maintain LR-biases. We also present an alternative hypothesis, which proposes that individual embryos stochastically choose one of several possible pathways with which to establish their LR axis. These two hypotheses are both tractable in appropriate model species; testing them to resolve open questions in the field of LR patterning will reveal interesting new biology of wide relevance to developmental, cell, and evolutionary biology.
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Affiliation(s)
- Laura N. Vandenberg
- Center for Regenerative and Developmental Biology, and Biology Department, Tufts University, Medford, MA 02155
| | - Michael Levin
- Center for Regenerative and Developmental Biology, and Biology Department, Tufts University, Medford, MA 02155
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Romaguera R, Roura G, Gómez-Hospital JA, Gómez-Lara J, Moris C, Cequier Á. Implante de bioprótesis aórtica CoreValve® en un paciente con situs inversus totalis con dextrocardia. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2012.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Maurer B, Geyer SH, Weninger WJ. A chick embryo with a yet unclassified type of cephalothoracopagus malformation and a hypothesis for explaining its genesis. Anat Histol Embryol 2012; 42:191-200. [PMID: 22971166 DOI: 10.1111/ahe.12002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 08/06/2012] [Indexed: 12/12/2022]
Abstract
Cephalothoracopagus embryos are conjoined twins, who share parts of their heads, necks and bodies. Our study aims at presenting a detailed morphological analysis of a cephalothoracopagus chick embryo of developmental stage 31. Because none of the existing theories can explain the genesis of the phenotype of this embryo, we also suggest a hypothesis, which explains it. Beside the cephalothoracopagus embryo, we investigated five control embryos. With the aid of the high-resolution episcopic microscopy (HREM) technique, we created digital volume data and three-dimensional (3D) computer models of the organs and arteries of the embryos. We used the 3D models for topological analysis and for measuring the diameters of the great intrathoracic arteries. The malformed embryo showed two body backs, each containing a notochord, spinal cord and dorsal aorta. The body backs continued into separated lower bodies. The embryo had a single, four-chambered heart, single respiratory tract and single upper alimentary tract. The topology of the pharyngeal arch arteries was normal, and the diameters of these arteries were similar to that of the control embryos. We classified the embryo we investigated as a yet unknown malformation and suggest a hypothesis explaining its genesis.
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Affiliation(s)
- B Maurer
- Integrative Morphology Group, Centre for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
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Successful radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia in a patient with dextrocardia and situs inversus. Herz 2012; 38:102-4. [PMID: 22955686 DOI: 10.1007/s00059-012-3666-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 07/02/2012] [Accepted: 07/25/2012] [Indexed: 10/27/2022]
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Kobza R, Cuculi F, Abächerli R, Toggweiler S, Suter Y, Frey F, Schmid JJ, Erne P. Twelve-lead electrocardiography in the young: physiologic and pathologic abnormalities. Heart Rhythm 2012; 9:2018-22. [PMID: 23102624 DOI: 10.1016/j.hrthm.2012.08.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Indexed: 11/26/2022]
Abstract
UNLABELLED BACKGROUND/ OBJECTIVE: The purpose of the present study was to analyze the prevalence of physiologic and pathologic ECG abnormalities in a cohort of young conscripts that represents the whole young generation of today. METHODS ECGs of all Swiss citizens who underwent conscription for the army during a 29-month period were analyzed manually. RESULTS ECGs of 43,401 conscripts (mean age 19.2 ± 1.1 years) were analyzed; 158 conscripts were female. Incomplete right bundle branch block was found in 5870 (13.5%) and left anterior fascicular block in 360 (0.83%). First-degree AV block was present in 329 (0.8%) and Mobitz type I (Wenckebach) second-degree AV block in 3 (0.01%). Early repolarization was observed in 1035 (2.4%), T-wave inversion in 39 (0.09%), and minor T-wave changes in 182 (0.42%). Brugada-like abnormalities were observed in 6 (0.01%). None of the conscripts had atrial fibrillation or flutter. CONCLUSION ECG abnormalities can be found in a relatively large proportion of young individuals. Incomplete right bundle branch block, left fascicular block, and first-degree AV block are the most frequent findings. No conscript presented with atrial fibrillation or flutter.
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Affiliation(s)
- Richard Kobza
- Division of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
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