Sinha Mumun, Pandey Niraj Nirmal, Sharma Arun, Kumar Sanjeev
Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India.
J Card Surg. 2020 Nov;35(11):2979-2986. doi: 10.1111/jocs.14960. Epub 2020 Aug 16.
To evaluate the imaging characteristics and associations in patients with twisted atrioventricular connections on multidetector computed tomography (CT) angiography.
We retrospectively reviewed 2605 CT angiography studies performed for suspected congenital heart diseases in our institution from January 2014 to December 2018. Twisted atrioventricular connections were diagnosed in 12 patients. Segmental sequential approach developed by Anderson et al was employed to characterize the complex congenital heart disease. Ventricular topology was also determined. CTA was also assessed to look for any associated intra- and extracardiac anomalies.
Out of 12 patients with twisted atrioventricular connections, usual viscero-atrial arrangement was seen in nine patients, two patients had mirror-imaged viscero-atrial arrangement and one patient had mirror-imaged atrial arrangement. Right-sided heart was seen in four patients. Two patients had discordant atrioventricular connections, seven had concordant atrioventricular connections while three showed double-inlet right ventricle. Ventriculoarterial connections were concordant in two patients, discordant in one patient while nine patients had double-outlet right ventricle. Superior-inferior ventricular morphology with near-horizontal interventricular septum was seen in four patients. Left-sided aortic arch with normal branching pattern was observed in nine patients. No coronary anomaly was seen in any patient. Other associations included ventricular and atrial septal defects, pulmonic stenosis, hypoplasia/atresia of tricuspid valve, straddling of mitral valve, and duplicated superior caval veins.
CT angiography is useful in diagnosis of twisted atrioventricular connections with accurate identification of viscero-atrial arrangement, atrioventricular and ventriculoarterial connections, and orientation and presence or absence of associated anomalies.
评估多排螺旋计算机断层扫描（CT）血管造影检查中房室连接异常患者的影像学特征及关联情况。
我们回顾性分析了2014年1月至2018年12月在我院进行的2605例疑似先天性心脏病的CT血管造影研究。12例患者被诊断为房室连接异常。采用Anderson等人提出的节段连续法对复杂先天性心脏病进行特征描述。同时确定心室拓扑结构。还对CT血管造影进行评估，以寻找任何心内和心外相关异常。
在12例房室连接异常患者中，9例患者可见正常的内脏-心房排列，2例患者有镜像内脏-心房排列，1例患者有镜像心房排列。4例患者为右位心。2例患者存在房室连接不一致，7例患者房室连接一致，3例患者表现为右心室双入口。2例患者心室-动脉连接一致，1例患者心室-动脉连接不一致，9例患者为右心室双出口。4例患者表现为上下心室形态，室间隔近水平。9例患者观察到左侧主动脉弓，分支模式正常。所有患者均未发现冠状动脉异常。其他关联包括室间隔和房间隔缺损、肺动脉狭窄、三尖瓣发育不全/闭锁、二尖瓣骑跨以及上腔静脉重复。
CT血管造影有助于诊断房室连接异常，能够准确识别内脏-心房排列、房室和心室-动脉连接以及相关异常的方向和有无情况。
