ISSN : 1301-5680
e-ISSN : 2149-8156
TURKISH JOURNAL OF
THORACIC AND
CARDIOVASCULAR SURGERY
Turkish Journal of Thoracic and Cardiovascular Surgery     
A retrospective analysis of cases with left atrial isomerism
Abdullah Erdem1, Cenap Zeybek2, Hacer Kamalı1, İlker Kemal Yücel3, Ali Yıldırım4, Numan Ali Aydemir5, Halil Türkoğlu6, Ahmet Çelebi3
1İstanbul Medipol Üniversitesi, Çocuk Kardiyolojisi Bilim Dalı, İstanbul, Türkiye
2Biruni Üniversitesi Tıp Fakültesi, Çocuk Kardiyolojisi Bilim Dalı, İstanbul, Türkiye
3Dr. Siyami Ersek Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi, Çocuk Kardiyolojisi Kliniği, İstanbul, Türkiye
4Eskişehir Osmangazi Üniversitesi Tıp Fakültesi, Çocuk Kardiyolojisi Bilim Dalı, İstanbul, Türkiye
5Dr. Siyami Ersek Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi, Çocuk Kalp Cerrahisi Kliniği, İstanbul, Türkiye
6İstanbul Medipol Üniversitesi, Çocuk Kalp Cerrahisi Bilim Dalı, İstanbul, Türkiye
DOI : 10.5606/tgkdc.dergisi.2017.14477
Background: In this study, we aimed to evaluate accompanying cardiac pathologies in patients with left atrial isomerism and report the follow-up results.

Methods: A total of 72 patients (25 males, 47 females; mean age 44.6±65.8 months; range 0 day to 255 months) with left atrial isomerism in two congenital heart diseases centers were retrospectively analyzed between July 2002 and December 2016. Clinical, radiological, electrocardiographic, echocardiographic, and angiocardiographic findings of the patients, surgical and transcatheter procedures, and postoperative follow-up data were recorded.

Results: The mean follow-up was 108±49.5 (range 12 to 173) months. Of 72 patients, four did not require surgery, while a permanent pacemaker was implanted in two patients. Of 68 patients who needed surgery, 17 were the candidates of biventricular correction, while the remaining 51 patients were the candidates of univentricular correction. The Kawashima procedure was performed in 29 patients. The pulmonary antegrade flow was left open in seven of these patients. In four patients, hepatic veins were incorporated into the Fontan circulation at the same session. In six patients, hepatic veins were directed to the pulmonary artery due to progressive cyanosis during follow-up using extracardiac conduit. Three patients died after surgery. Mortality or progressive cyanosis was not observed in any patients in whom the hepatic veins were incorporated into the Fontan circulation at the same or in another session, or in the patients in whom the antegrade flow was left open.

Conclusion: The overall prognosis is excellent in patients with biventricular physiology. However, tissue oxygenation tends to fall in patients undergoing Kawashima procedure. Therefore, incorporation of the hepatic veins into the pulmonary circulation at the same session, or leaving the antegrade flow open in suitable cases seems to be a safe approach in patients undergoing Kawashima procedure.

Keywords : Interrupted vena cava inferior; isomerism; Kawashima
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