Progress
in Pediatric Cardiology 55 (2019) 101149
Accepted
11 September 2019
1058-9813/ © 2019 Elsevier B.V.
Determining situs by abdominal aorta and inferior vena caval findings: It is neither complicated nor ambiguus
Author
William N. Evans, Ruben J. Acherman, Humberto
Restrepo
Source
Corresponding
authors at: Children's Heart Center Nevada, 3006 S. Maryland Pkwy, Ste. 690,
Las Vegas, NV 89109, USA.
E-mail addresses:
wnevans50@aol.com (W.N. Evans), hurescan@gmail.com (H. Restrepo).
Abstract
We reviewed our
center's experience with isomeric situs for those identified prenatally or born
between 2003 and 2018. We defined left isomerism as an absent
hepatic portion
of the inferior vena cava with azygos/hemiazygos venous return to the superior
vena cava. We defined right isomerism as an ipsilateral abdominal
inferior vena
cava and aorta. For the period 2003 to 2018, we identified 101 patients that
met criteria. Of the 101, 70 (69%) had left isomerism, and 31 (31%) had
right isomerism.
Of the 101 patients, 89 were live born. For those with left isomerism, 24/70
(34%) had functionally univentricular hearts versus 30/31 (97%) with
right isomerism
(p=0.00001). Overall mortality for live-born patients was higher for right
isomerism 42% versus 13% for left isomerism (p=0.029). For the period
2014–2018, 27/27
(100%) of patients with isomerism were diagnosed prenatally compared to 29/57
(51%) for the period 2003–2013 (p=0.0003). In conclusion,
left or right
isomerism can be determined by ultrasound imaging of the abdominal aorta and
inferior vena caval relationships. To date, all
patients have had a
discernable situs
without any deemed uncertain. Further, our current prenatal diagnosis of
isomerism stands at 100%.