Ventricular morphology and coronary arterial anatomy in hearts with isomeric atrial appendages

Background. Knowledge of the precise anatomy can be advantageous when striving to improve surgical results in patients with visceral heterotaxy. Methods. We studied the ventricular mass, and its coronary arterial supply, in 125 specimens with isomeric right and 58 with isomeric left appendages. Results. The situation in which each atrium connected to its own ventricle was the most common arrangement in hearts with isomeric left appendages. The pattern with both atriums connecting to the same ventricle was more frequently seen in those with isomeric right appendages. Concordant ventriculoarterial connections were seen in only 4% of cases with isomeric right appendages, but were seen in 45% of those with isomeric left appendages. Abnormal patterns in branching of the coronary arteries were commonly associated with abnormal ventricular architecture. The morphologically right or left ventricular arteries were frequently lacking in those hearts with a dominant ventricle and a rudimentary and incomplete ventricle. A solitary coronary artery was seen in 13%. Conclusions. Recognition of these abnormalities is of clinical importance if optimal surgical strategies are to be established for patients with visceral heterotaxy.