Heterotaxia Isomerism

Presentation on Heterotaxia

Wonderful presentation prepared by Dr Pasinee Kanaprach (Fellow in Neonatal Hemodynamics) and Dr Ida Whiteman (Fellow in Advanced Cardic Imaging) at McGill University in the context of the NICU-Cardio Rounds at the Montreal Children's Hospital on September 13th, 2023. Also a mention to thank Dr Wadi Mawad who provided slides and images from a previous talk to assist in the preparation of this talk.

Heterotaxy Neocardiolab 1.pdf

Echocardiography outlining left atrial isomerism with interrupted IVC with azygous continuation to left SVC

Parasternal long axis view outlining the very dilated coronary sinus secondary to the venous return of the left SVC, which contains the venous return from the azygos vein draining the lower body.

Persistence left SVC may be associated with a left-sided obstruction. Here we outline that the aorta is open and non-obstructed. There is a common origin of the innominate and left common carotid artery - often referred too "Bovine Arch". Even though we may sometimes use the term "Bovine arch" to describe certain aortic arch variations, it is important to note that genuine bovine arches have no similarity to the common aortic arch variations typically found in humans. 

One may appreciate from this view the left SVC draining to the coronary sinus by B-Mode

Evaluation of the situs outlines the absence of the inferior vena cava. However, a vessel is seen posterior and to the left of the aorta. This vessel is the Azygos vein.

Subcostal short axis view outlining the absence of a "Bicaval" view . Subhepatic veins are seen connecting to the right atrium, but not the inferior vena cava. 

Sweep in the long-axis subcostal view outlining the absence of a IVC connecting to the right atrium. 

Significant enlargement of the coronary sinus found in the posterior view of the apical 4 chamber view, draining to the right atrium.

Azygos vein is seen running parallel to the descending aorta. In this case, it travels upstream and drains in the left SVC. 

Interruption of the hepatic IVC. Rerouting of the blood flow to the azygos vein. See with colour.

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