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A Rare Case of Polysplenia Syndrome Associated with Severe Cardiac Malformations and Congenital Alveolar Dysplasia in a One-Month-Old Infant: A Complete Macroscopic and Histopathologic Study. J Cardiovasc Dev Dis 2022; 9:jcdd9050135. [PMID: 35621846 PMCID: PMC9144318 DOI: 10.3390/jcdd9050135] [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: 03/15/2022] [Revised: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 02/05/2023] Open
Abstract
Polysplenia syndrome represents a type of left atrial isomerism characterized by multiple small spleens, often associated with cardiac malformations and with situs ambiguus of the abdominal organs. The case presented is of a one-month-old male infant, weighing approximately 3000 g, born at the County Clinical Emergency Hospital of Sibiu, who was hospitalized from birth until death. The patient suffered cardio-respiratory arrest due to severe hypoxia and septicemia on the background of a series of complex cardiac malformations associated with congenital abdominal organ anomalies. Examination of the body revealed a common atrium with complete atrioventricular canal defect, left ventricular hypertrophy, right ventricle hypoplasia, truncus arteriosus, superior vena cava duplication, bilobation of the lungs, situs ambiguous of the abdominal organs with right-sided stomach, a midline liver, gall bladder agenesis, multiple right-sided spleens and complete inversion of the intestines and pancreas. Histopathology concluded that the patient suffered cardiac lesions consistent with infantile lactic acidosis, as well as pulmonary modifications suggesting congenital alveolar dysplasia and altered hepatic architecture compatible with fibrosis.
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Elhattabi K, Elyamine O, Bouali M, El Bakouri A, Bensardi F, Fadil A. Polysplenia with agenesis of the dorsal pancreas and preduodenal portal vein, about a case. Int J Surg Case Rep 2020; 76:357-360. [PMID: 33074136 PMCID: PMC7569255 DOI: 10.1016/j.ijscr.2020.10.005] [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] [Received: 07/18/2020] [Revised: 10/03/2020] [Accepted: 10/03/2020] [Indexed: 10/27/2022] Open
Abstract
PURPOSE OF THE STUDY Polysplenia is a complex polymalformative syndrome that is frequently accompanied by an inconsistent spectrum of visceral and vascular anatomical abnormalities and is extremely undiscovered in adulthood. The objective of this article is to limit the intraoperative risks generated by the lack of knowledge of these anatomical variations by insisting on the inconstancy of all these variations and the perfect knowledge of the reference anatomy and the exploration of the anatomical variations in imaging before the surgery. PATIENT AND METHODS The patient was 50-year-old who was hospitalized in our department for gastric adenocarcinoma. During her extension assessment, a polysplenia syndrome was accidentally discovered on the scan images, which showed an exceptional association between preduodenal portal vein, agenesis of the dorsal pancreas, and polysplenia. CONCLUSION There are neither specific clinical symptoms of the polysplenia syndrome, nor any biological sign; hence, the interest of recognizing this pathology is to avoid diagnostic errors, but also to guide the surgeon during the surgical act performed.
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Affiliation(s)
- Khalid Elhattabi
- Department of Visceral Surgical Emergencies, University Hospital Center Ibn Rochd, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
| | - Othmane Elyamine
- Department of Visceral Surgical Emergencies, University Hospital Center Ibn Rochd, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
| | - Mounir Bouali
- Department of General Surgery, University Hospital Center Ibn Rochd, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
| | - Abdelilah El Bakouri
- Department of Visceral Surgery, University Hospital Center Ibn Rochd, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
| | - Fatimazahra Bensardi
- Department of Visceral Surgery, University Hospital Center Ibn Rochd, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
| | - Abdelaziz Fadil
- Department of Visceral Surgery, University Hospital Center Ibn Rochd, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
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Tchervenkov CI, Bernier PL, Duca DD, Hill S, Ota N, Samoukovic G, Al-Habib H, Korkola S. Repair of atrioventricular canal with double-outlet right ventricle, transposition, or truncus arteriosus. World J Pediatr Congenit Heart Surg 2010; 1:119-26. [PMID: 23804732 DOI: 10.1177/2150135110362093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Atrioventricular canal and conotruncal anomalies are a heterogeneous group of lesions presenting unique challenges for surgical repair. These are the establishment of unobstructed pathways from left ventricle (LV) to aorta and from right ventricle (RV) to pulmonary artery, closure of the inlet ventricular septal defect (VSD) and atrial septal defect (ASD) ostium primum, and the avoidance of significant left and right atrioventricular valve (AV) regurgitation. Repair of complete atrioventricular canal (CAVC) with tetralogy of Fallot (TOF) has been most commonly achieved, either using a single-patch or a 2-patch technique. In patients with CAVC with double-outlet right ventricle (DORV) with subaortic VSD extension, the 2-patch repair is not unlike that of CAVC with TOF. However, biventricular repair is most challenging in patients with CAVC and complete origin of the aorta from the RV, as in CAVC with DORV and noncommitted VSD and those with CAVC with transposition of the great arteries (TGA) and LVOTO. The technique of VSD translocation allows anatomic biventricular repair for these particularly challenging patients. The arterial switch operation with CAVC repair can be used for patients with CAVC with DORV with subpulmonary VSD extension and CAVC with TGA without left ventricular outflow tract obstruction. Biventricular repair is achievable in most patients with balanced complete atrioventricular canal and conotruncal anomaly. The extreme heterogeneity of CAVC with conotruncal anomalies requires a highly individual approach that is tailored to the specific constellation of lesions in each patient.
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Affiliation(s)
- Christo I Tchervenkov
- Montreal Children's Hospital of the McGill University Health Center, Montreal, Québec, Canada
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Gotsch F, Romero R, Espinoza J, Kusanovic JP, Erez O, Hassan S, Yeo L. Prenatal diagnosis of truncus arteriosus using multiplanar display in 4D ultrasonography. J Matern Fetal Neonatal Med 2010; 23:297-307. [PMID: 19900032 PMCID: PMC3437769 DOI: 10.3109/14767050903108206] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Prenatal diagnosis of truncus arteriosus with two-dimensional sonography requires expertise in fetal echocardiography. Indeed, truncus arteriosus shares with tetralogy of Fallot and pulmonary atresia with a ventricular septal defect (VSD) the sonographic finding of a single arterial trunk overriding a VSD. The diagnosis of truncus arteriosus can be confirmed when either the main pulmonary artery or its branches are visualized arising from the truncus itself. This requires sequential examination of multiple scanning planes and a process of mental reconstruction of their spatial relationships. The advantage of multiplanar imaging in three-dimensional and four-dimensional ultrasonography is that it allows for the simultaneous visualization of three orthogonal anatomic planes, which can be very important in diagnosing cardiac abnormalities. We report, first, a case of truncus arteriosus diagnosed in utero where the multiplanar display modality provided important insight into the differential diagnosis of this conotruncal anomaly, and then, review the diagnosis of truncus arteriosus on ultrasound.
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Affiliation(s)
- Francesca Gotsch
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, MD and Detroit, MI, USA
| | - Roberto Romero
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, MD and Detroit, MI, USA
- Center For Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Jimmy Espinoza
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, MD and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Juan Pedro Kusanovic
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, MD and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Offer Erez
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, MD and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Sonia Hassan
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, MD and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Lami Yeo
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, MD and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
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Adachi I, Ho SY, Bartelings MM, McCarthy KP, Seale A, Uemura H. Common Arterial Trunk With Atrioventricular Septal Defect: New Observations Pertinent to Repair. Ann Thorac Surg 2009; 87:1495-9. [DOI: 10.1016/j.athoracsur.2009.02.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2008] [Revised: 02/17/2009] [Accepted: 02/18/2009] [Indexed: 11/27/2022]
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Singh HR, Pettersen MD. Atrioventricular septal defect with common atrioventricular junction, common arterial trunk, and severe coarctation of the aorta in a patient with Down's syndrome. Cardiol Young 2007; 17:226-8. [PMID: 17291394 DOI: 10.1017/s104795110700025x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2006] [Indexed: 11/05/2022]
Abstract
Atrioventricular septal defect with common atrioventricular junction is rarely associated with either a common arterial trunk or coarctation of the aorta. We report, as far as we are aware, the first case of Down's syndrome with atrioventricular septal defect with common atrioventricular junction, common arterial trunk, and severe coarctation of the aorta.
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Affiliation(s)
- Harinder R Singh
- Division of Cardiology, The Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan 48201, USA.
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Chintala K, Gurczynski J, Aggarwal S. Prenatal diagnosis of complete atrioventricular septal defect with truncus arteriosus. Prenat Diagn 2007; 27:560-2. [PMID: 17380467 DOI: 10.1002/pd.1716] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Truncus arteriosus (TA) is a rare cardiac anomaly constituting less than 1% of all congenital heart defects. Its association with complete atrioventricular septal defect (AVSD) is extremely unusual and only 12 cases diagnosed postnatally or postmortem have been reported so far. We describe the first case of truncus arteriosus with AVSD to be diagnosed prenatally by fetal echocardiography.
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Affiliation(s)
- Kavitha Chintala
- Division of Cardiology, Children's Hospital of Michigan, Wayne State University, Detroit 48201, USA.
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