Abstract
In the sequential segmental approach to diagnosing congenital heart disease, the morphological arrangement of the atria is the starting point [1, 2]. The appendages are the most constant component of the atria. Their shape and the morphology of their junction with the atria always show a morphologically right or left pattern. The morphologically left atrial appendage is tubular and hook-shaped, with a narrow junction with the venous portion of the atrium. The vestibular aspect of the left atrium is smooth, as the pectinate muscles are restricted to the appendage. The morphologically right atrial appendage is essentially triangular, with a broad junction with the venous portion of the atrium. Its internal aspect contains pectinate muscles that extend around the atrioventricular junction and reach thecrux of the heart (Fig. 3.1) [3].
In this specimen of a normal heart, viewed form above, the upper portion of the atria is sectioned to show the “floor” of the atria with their appendages. The different size of the junction of the atrial appendages (white brackes) and different distribution of the pectinated muscles (yellow dotted line) within each atrium is demonstrated. AV aortic valve, LA left atrium, LAA left atrial appendage, PV pulmonary valve, RA right atrium, RAA right atrial appendage
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References
Shinebourne EA, Macartney FJ, Anderson RH (1976) Sequential chamber localization — logical approach to diagnosis in congenital heart disease. Br Heart J 38:327–340
Anderson RH, Becker AE, Freedom RM et al (1984) Sequential segmental analysis of congenital heart disease. Pediatr Cardiol 5:281–288
Ho SY, Baker EJ, Rigby ML et al (1995) The normal heart. In Congenital heart disease. Mosby-Wolfe, London, pp 7–24
Chaoui R (2003) Cardiac malpositions and syndromes with right or left atrial isomerism In: Gembruch U (ed) Fetal cardiology, Martin Dunitz, London, pp 173–182
Berg C, Geipel A, Kohl T et al (2005) Fetal echocardiographic evaluation of atrial morphology and the prediction of laterality in cases of heterotaxy syndromes Ultrasound Obstet Gynecol 26: 538–545
Allan LD, Crawford DC, Anderson RH et al (1984) Echocardiographic and anatomical correlations in fetal congenital heart disease. Br Heart J 52:542–548
Silverman NH, Schmidt KG (1994) Ultrasound evaluation of the fetal heart. In Callen PW (ed) Ultrasonography in obstetries and gynecology, WB Saunders, Philadelphia, pp 291–332
Bronshtein M, Gover A, Zimmer EZ (2002) Sonographic definition of the fetal situs. Obstet Gynecol 99:1129–1130
De Vore GR, Sarti DA, Siassi B et al (1986) Prenatal diagnosis of cardiovascular malformations in the fetus with situs inversus viscerum during the second trimester of pregnancy. J Clin Ultrasound 14:454–457
Bernasconi A, Azancot A, Simpson JM et al (2005) Fetal dextrocardia: diagnosis and outcome in two tertiary centres. Heart 91:1590–1594
Ortiga DJ, Chiba Y, Kanai H et al (2001) Antenatal diagnosis of mirror-image dextrocardia in association with situs inversus and Turner’s mosaicism. J Matern Fetal Med 10:357–359
Holzmann D, Ott PM, Felix H (2000) Diagnostic approach to primary ciliary dyskinesia: a review. Eur J Pediatr 159(1–2):95–98
Sapire DW, Ho SY, Anderson RH et al (1986) Diagnosis and significance of atrial isomerism. Am J Cardiol 58:342–346
Ho SY, Cook A, Anderson RH et al (1991) Isomerism of the atrial appendages in the fetus. Pediatr Pathol 11:589–608
Allan LD, Sharland G, Cook A (1994) Atrial isomerism. In: Color atlas of fetal cardiology. Mosby-Wolfe, London, pp 33–42
Uemura H, Ho SY, Devine WA et al (1995) Atrial appendages and venoatrial connections in hearts from patients with visceral heterotaxy. Ann Thorac Surg 60:561–569
Anderson RH, Becker AE (1997) Isomerism of the atrial appendages. In: Controversies in the description of congenitally malformed hearts. Imerial College Press, London, pp 67–112
Berg C, Geipel A, Smrcek J et al (2003) Prenatal diagnosis of cardiosplenic syndromes: a 10-year experience. Ultrasound Obstet Gynecol 22:451–459
Sheley RC, Nyberg DA, Kapur R (1995) Azygous continuation of the interrupted inferior vena cava: a clue to prenatal diagnosis of the cardiosplenic syndromes. J Ultrasound Med 14:381–387
Schmidt KG, Ulmer HE, Silverman NH et al (1991) Perinatal outcome of fetal complete atrioventricular block: a multicenter experience. J Am Coll Cardiol 17:1360–1366
Phoon CK, Villegas MD, Ursell PC et al (1996) Left atrial isomerism detected in fetal life. Am J Cardiol 77:1083–1088
Davenport M, Howard ER (1992) Biliary atresia and the polysplenia syndrome. J Pediatr Surg 27(4):539–540
Chandra RS (1974) Biliary atresia and other structural anomalies in congenital polysplenia syndrome. J Pediatr 85:649–655
Sharland G, Cook A (2000) Heterotaxy syndromes/ isomerism of the atrial appendages. In: Textbook of fetal cardiology. Green wich Medical Media, London, pp 335–346
Berg C, Geipel A, Kamil D et al (2006) The syndrome of right isomerism — prenatal diagnosis and outcome Ultraschall Med 27(3):225–233
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(2008). The Visceroatrial Arrangement (Situs). In: Echocardiographic Anatomy in the Fetus. Springer, Milano. https://doi.org/10.1007/978-88-470-0573-0_3
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DOI: https://doi.org/10.1007/978-88-470-0573-0_3
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