Determining Situs by Abdominal Aorta and Inferior Vena Caval Findings: It is Neither Complicated Nor Ambiguus

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Progress in Pediatric Cardiology



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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%.


Medical Specialties | Medicine and Health Sciences | Pediatrics



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