Stümper O, Rijlaarsdam M, Vargas-Barron J, Romero A, Hess J, Sutherland G R
Academisch Ziekenhuis Rotterdam-Dijkzigt, Sophia Children's Hospital and Thoraxcenter, Rotterdam, The Netherlands.
Int J Cardiol. 1990 Dec;29(3):365-71. doi: 10.1016/0167-5273(90)90127-q.
As part of a prospective study into the diagnostic role of transoesophageal echocardiography in children with complex congenital heart disease, the atrial morphology was assessed in 62 children. Using the direct visualization of atrial appendage morphology, 58 were shown to have usual atrial arrangement, two were documented to have isomerism of the right and two isomerism of the left appendages. Of those with usual arrangement, four children were demonstrated to have left juxtaposition of the atrial appendages. Only two of these patients were identified during praecordial echocardiographic re-evaluation, and three on angiocardiographic examination. Surgical confirmation was obtained in three, and juxtaposition was excluded in the remaining cases. The transoesophageal cross-sectional imaging features of left juxtaposition of the atrial appendages are unique and readily diagnostic of this entity. They include, first, a lateral deviation of the acid-portion of the atrial septum and, second, a frontal orientation of the antero-superior portion forming the floor and the posterior wall of the junction of the right-sided atrial appendage with the venous component of the atrial cavity. The knowledge of these morphologic characteristics is important, as, otherwise, this malformation may be misinterpreted as representing an atrial septal defect. The results suggest that transoesophageal echocardiography will be the most sensitive preoperative diagnostic technique in detecting or excluding juxtaposed atrial appendages.
作为一项关于经食管超声心动图在复杂先天性心脏病患儿诊断中作用的前瞻性研究的一部分，对62例患儿的心房形态进行了评估。通过直接观察心耳形态，发现58例患儿心房排列正常，2例记录为右心耳异构，2例为左心耳异构。在心房排列正常的患儿中，有4例显示有心耳左并置。这些患者中只有2例在胸前超声心动图复查时被发现，3例在心血管造影检查时被发现。3例经手术证实，其余病例排除并置。心耳左并置的经食管横断面成像特征独特，易于诊断。这些特征包括：第一，房间隔酸部分的外侧偏移；第二，形成右侧心耳与心房腔静脉部分交界处的前上部分的额面取向。了解这些形态学特征很重要，否则这种畸形可能会被误诊为房间隔缺损。结果表明，经食管超声心动图将是检测或排除并置心耳最敏感的术前诊断技术。
