DOCSLIB.ORG

Visceral Situs, Heart Position, and Aortic Arch Position 69

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Visceral Situs, Heart Position, and Aortic Arch Position 69 Visceral Situs, Heart Position, 7 and Aortic Arch Position The second step in interpretation of a chest radiograph and (6) the azygos vein. The basic concepts regarding vis- obtained in a new patient is to ascertain visceral situs, the ceral situs is discussed in detail in Chapter 2. heart position, and the position of the aortic arch relative In situs solitus, the gastric air bubble is on the left side, to the trachea. For example, the radiographic report may and the larger lobe of the liver is on the right side (Fig. 7.2). start with this sentence: “The radiograph shows situs solitus, The splenic tip can often be identified when the stomach levocardia and a left aortic arch.” and adjacent bowel loops are filled with air. When the bronchial air column can be traced, an asymmetric bronchial branching pattern with a short right and a long left main bronchus can be appreciated on the frontal radi- ■ Visceral Situs ograph. Normally the left main bronchus is 1.5 to 2 times longer than the right main bronchus. At the pulmonary Visceral situs refers to the pattern of arrangement of the hilum, the left pulmonary artery is seen slightly higher body organs relative to the midline. There are four types than the right pulmonary artery. The left pulmonary of visceral situs: situs solitus, situs inversus, heterotaxy artery is seen above the left upper lobe bronchus, with thoracic right isomerism, and heterotaxy with whereas the right pulmonary artery (in fact, its descend- thoracic left isomerism (Fig. 7.1).1–4 Visceral heterotaxy ing branch) is seen below the right upper lobe bronchus. has also been described as situs ambiguus, which means An asymmetric branching pattern of the bronchi and pul- uncertain situs. This term should be abandoned because monary arteries is also evident on the lateral radiograph. the situs is not uncertain but rather needs more words to As the upper lobe bronchi normally have horizontal describe it precisely. The structures that are helpful in de- courses, they are seen as two round lucencies arranged termination of the situs include (1) the gastric air bubble, superoinferiorly in the middle mediastinum. The right (2) the larger lobe of the liver, (3) the tip of the spleen, (4) upper lobe bronchus is located approximately one verte- the bronchi and pulmonary arteries, (5) the minor fissure, bral height above the left upper lobe bronchus. The right Fig. 7.1 Four types of visceral situs. GB, gallbladder; IVC, inferior vena cava; PA, pulmonary artery; SVC, superior vena cava. 68 7 Visceral Situs, Heart Position, and Aortic Arch Position 69 Fig. 7.2 Situs solitus. Magnified views of the hilar anatomy (lower panels). Asterisks on the magnified frontal view mark the upper lobe bronchi. The left main bronchus is twice as long as the right main bronchus in this individual (solid lines). pulmonary artery lies anterior and slightly inferior to the the lateral view with a right-sided gastric bubble on the right upper lobe bronchus. The left pulmonary artery lies frontal view is highly suggestive of situs inversus even if posterior and superior to the left upper lobe bronchus. In the splenic shadow is not identified. short, the right upper lobe bronchus lies higher than the In right isomerism, the hepatic shadow usually extends left, and the left pulmonary artery lies higher than and across the upper abdomen (Fig. 7.4). The gastric bubble posterior to the right pulmonary artery. The minor fissure can be seen on either side but tends to be closer to the may cast a horizontal linear shadow over the midzone of midline. Interestingly, about 15% of patients with right a trilobed right lung. isomerism have a hiatal hernia (Fig. 7.5).5 Hiatal hernia Situs inversus is characterized by a mirror-image can be regarded as a manifestation of visceral heterotaxy. arrangement of the visceral organs (Fig. 7.3). The gastric Bilaterally short bronchi can be appreciated in a well- bubble is on the right and the larger lobe of the liver on taken frontal radiograph (Fig. 7.6). However, this feature the left. However, it is important to understand that the is often unclear in infants. On the lateral radiograph, situs should not be called “situs inversus” solely because the end-on shadows of the upper lobe bronchi are seen at of the inverted positions of the gastric bubble and hepatic the same or similar horizontal level, and the pulmonary shadow. Plain film diagnosis of situs inversus can only be arterial shadow is seen mostly in front of the bronchi made when an inverted bronchial and pulmonary arterial (Fig. 7.4). The presence of bilateral minor fissures indicates branching pattern is clear. A lateral radiograph is helpful right isomerism (Fig. 7.7). In fact the diagnosis of right in differentiating the lateralized situs (i.e., situs solitus isomerism can be entertained when the minor fissure is and inversus) from the symmetric situs (i.e., right iso- present on the same side as the stomach even when a minor merism or left isomerism). Normal hilar arrangement of fissure is identified only on one side (Fig. 7.4, left panel). the upper lobe bronchi and branch pulmonary arteries on This is because the minor fissure and stomach cannot be 70 II Systematic Approach to Chest Radiographs Fig. 7.3 Situs inversus. The frontal view shows mirror-image arrange- situs solitus (Fig. 7.2) but note the difference in labeling. This patient ment of the bronchial and pulmonary arterial trees. Asterisks mark the had Kartagener’s syndrome with subtle pulmonary infiltrates in the upper lobe bronchi.The lateral view appears identical to that seen in right lower lung. on the same side in either situs solitus or situs inversus, congenital heart disease in almost all cases. We have not and no minor fissure is present in either lung in left iso- seen any single case of right isomerism without complex merism. However, a potential pitfall is the presence of an congenital heart disease. As pulmonary atresia or stenosis accessory fissure, which can simulate a horizontal fissure is present in the majority of cases, the pulmonary vascu- (Fig. 7.8).6,7 Right isomerism is associated with complex larity is usually reduced (Figs. 7.4, 7.5, 7.6, and 7.7). Fig. 7.4 Heterotaxy with thoracic right isomerism. The hepatic silhou- evidence of right isomerism. On the lateral view, the similar length of ette extends symmetrically across the upper abdomen. The stomach the right and left main bronchi results in the upper lobe bronchi being with a nasogastric tube in place is on the right side, lying somewhat projected at a similar horizontal level. The right and left pulmonary close to the midline. A minor fissure is visible in the right lung. The arteries are projected mostly in front of the upper lobe bronchi. presence of a minor fissure on the same side of the stomach is conclusive 7 Visceral Situs, Heart Position, and Aortic Arch Position 71 Fig. 7.5 Ectopic location of a part of the stomach in the thorax, which is often described as hiatal hernia, in a neonate with abdominal heterotaxy and thoracic right isomerism. Left isomerism is also characterized by a symmetric solitus or inversus (Fig. 7.9). The gastric bubble can be visceral arrangement. However, the hepatic shadow in on either side. The splenic shadow can be identified left isomerism is usually less symmetric than in right along the greater curvature of the stomach. On the isomerism, and it is not uncommon for the hepatic frontal radiograph, bilaterally long bronchi can often be shadow to be indistinguishable from that seen in situs appreciated (Fig. 7.9, right panels). On the lateral radi- ograph, the upper lobe bronchi cast end-on shadows at the same or similar horizontal level, and the pulmonary arterial shadow is mostly seen behind the bronchi. The presence of a minor fissure in either lung excludes the Fig. 7.6 Symmetrically short main bronchi are shown in this frontal radiograph in a child with right isomerism. This feature is not usually as apparent in neonates and small children. Asterisks indicate the origins Fig. 7.7 Bilateral minor fissures (arrows) in a neonate with right of the upper lobar bronchi. isomerism. 72 II Systematic Approach to Chest Radiographs diagnosis of left isomerism. In approximately 80% of cases, left isomerism is associated with interruption of the inferior vena cava with azygos or hemiazygos venous continuation.8 In this situation, the dilated azygos vein can be identified in the area of the tracheobronchial angle (Fig. 7.9, left panels). Absence of the inferior vena caval shadow on the lateral radiograph has also been described in patients with an interrupted inferior vena cava. We find this feature unreliable. As interruption involves the postrenal prehepatic segment of the infe- rior vena cava, the posthepatic segment of the inferior vena cava is present and collects the hepatic veins. Therefore, a web-like shadow, albeit somewhat smaller than normal, can be identified in the lateral radiograph. In addition, the inferior vena caval shadow can be hid- den by the posteriorly enlarged heart. In contrast to right isomerism, left isomerism is not always associated with congenital heart disease. Left isomerism may be seen as an incidental finding in otherwise normal indi- Fig. 7.8 Accessory left anomalous fissure simulating the appearance viduals or in patients with an arrhythmia or biliary of bilateral minor fissures in an infant with situs solitus and hypoplas- atresia.9 tic left heart syndrome. Right isomerism was suspected, but there was a situs solitus arrangement of the other organs.
Load more

Recommended publications
  • Laparoscopic Cholecystectomy in Situs Inversus Totalis: Case Report with Review of Techniques
    CASE REPORT – OPEN ACCESS International Journal of Surgery Case Reports 59 (2019) 208–212 Contents lists available at ScienceDirect International Journal of Surgery Case Reports j ournal homepage: www.casereports.com Laparoscopic cholecystectomy in situs inversus totalis: Case report with review of techniques ∗ Omar AlKhlaiwy, Ahmed Mohammed AlMuhsin , Eman Zakarneh, Mohamed Yassin Taha Department of General Surgery, King Fahd Military Medical Complex, Dhahran, Saudi Arabia a r t i c l e i n f o a b s t r a c t Article history: INTRODUCTION: Situs inversus totalis (SIT) is a congenital disorder in which the visceral organs are mir- Received 18 January 2019 rored from their normal anatomical position. Diagnosis and management of cholelithiasis in patient with Received in revised form 21 March 2019 SIT poses a challenge due to the underlying anatomical variation. Accepted 23 May 2019 PRESENTATION OF CASE: We report a case of a 40-year-old male patient who presented with an intermit- Available online 31 May 2019 tent history of epigastric and left upper quadrant pain for one month. Clinical assessment and radiological investigations confirmed the presence of cholelithiasis with evidence of SIT. The patient underwent elec- Keywords: tive laparoscopic cholecystectomy with no complication and he had an uneventful recovery. Various Situs inversus totalis intraoperative modification has been made to overcome the technical difficulties encountered due to the Laparoscopic cholecystectomy underlying anatomical variation. Case report DISCUSSION: Since the first successful laparoscopic cholecystectomy in patient with SIT performed in 1991, 85 cases have been reporsted in the literature. Surgeons managed to overcome the technical dif- ficulties by adopting various modification in the techniques compared to the conventional laparoscopic cholecystectomy.
    [Show full text]
  • Congenital Cardiac Surgery ICD9 to ICD10 Crosswalks Page 1 of 4 8
    Congenital Cardiac Surgery ICD9 to ICD10 Crosswalks ICD-9 code ICD-9 Descriptor ICD-10 Code ICD-10 Descriptor 164.1 Malignant neoplasm of heart C38.0 Malignant neoplasm of heart 164.1 Malignant neoplasm of heart C45.2 Mesothelioma of pericardium 212.7 Benign neoplasm of heart D15.1 Benign neoplasm of heart 425.11 Hypertrophic obstructive cardiomyopathy I42.1 Obstructive hypertrophic cardiomyopathy 425.18 Other hypertrophic cardiomyopathy I42.2 Other hypertrophic cardiomyopathy 425.3 Endocardial fibroelastosis I42.4 Endocardial fibroelastosis 425.4 Other primary cardiomyopathies I42.0 Dilated cardiomyopathy 425.4 Other primary cardiomyopathies I42.5 Other restrictive cardiomyopathy 425.4 Other primary cardiomyopathies I42.8 Other cardiomyopathies 425.4 Other primary cardiomyopathies I42.9 Cardiomyopathy, unspecified 426.9 Conduction disorder, unspecified I45.9 Conduction disorder, unspecified 745.0 Common truncus Q20.0 Common arterial trunk 745.10 Complete transposition of great vessels Q20.3 Discordant ventriculoarterial connection 745.11 Double outlet right ventricle Q20.1 Double outlet right ventricle 745.12 Corrected transposition of great vessels Q20.5 Discordant atrioventricular connection 745.19 Other transposition of great vessels Q20.2 Double outlet left ventricle 745.19 Other transposition of great vessels Q20.3 Discordant ventriculoarterial connection 745.19 Other transposition of great vessels Q20.8 Other congenital malformations of cardiac chambers and connections 745.2 Tetralogy of fallot Q21.3 Tetralogy of Fallot 745.3 Common
    [Show full text]
  • A Human Laterality Disorder Associated with a Homozygous WDR16 Deletion
    European Journal of Human Genetics (2015) 23, 1262–1265 & 2015 Macmillan Publishers Limited All rights reserved 1018-4813/15 www.nature.com/ejhg SHORT REPORT A human laterality disorder associated with a homozygous WDR16 deletion Asaf Ta-Shma*,1,3, Zeev Perles1,3, Barak Yaacov2, Marion Werner2, Ayala Frumkin2, Azaria JJT Rein1 and Orly Elpeleg2 The laterality in the embryo is determined by left-right asymmetric gene expression driven by the flow of extraembryonic fluid, which is maintained by the rotary movement of monocilia on the nodal cells. Defects manifest by abnormal formation and arrangement of visceral organs. The genetic etiology of defects not associated with primary ciliary dyskinesia is largely unknown. In this study, we investigated the cause of situs anomalies, including heterotaxy syndrome and situs inversus totalis, in a consanguineous family. Whole-exome analysis revealed a homozygous deleterious deletion in the WDR16 gene, which segregated with the phenotype. WDR16 protein was previously proposed to play a role in cilia-related signal transduction processes; the rat Wdr16 protein was shown to be confined to cilia-possessing tissues and severe hydrocephalus was observed in the wdr16 gene knockdown zebrafish. The phenotype associated with the homozygous deletion in our patients suggests a role for WDR16 in human laterality patterning. Exome analysis is a valuable tool for molecular investigation even in cases of large deletions. European Journal of Human Genetics (2015) 23, 1262–1265; doi:10.1038/ejhg.2014.265; published online 3 December 2014 INTRODUCTION and development, followed till 7 years, were normal. Her younger brother, Visceral asymmetry is determined through embryonic ciliary motion, patient II-4, was brought to medical attention at 7 weeks of age because of viral and normal function of the motile cilia plays a key role in the bronchiolitis.
    [Show full text]
  • Isolated Levocardia with Situs Inversus Without Cardiac Abnormality in Fetus: Prenatal Diagnosis and Management
    A L J O A T U N R I N R A E L P Case Report P L E R A Perinatal Journal 2020;28(1):48–51 I N N R A U T A L J O ©2020 Perinatal Medicine Foundation Isolated levocardia with situs inversus without cardiac abnormality in fetus: prenatal diagnosis and management Mucize Eriç ÖzdemirİD , Oya Demirci İD Department of Perinatology, Zeynep Kamil Maternity and Children’s Diseases Training and Research Hospital., Health Sciences University, Istanbul, Turkey Abstract Özet: Kardiyak anomalisi olmayan fetüste situs inversuslu izole levokardi: Prenatal tan› ve yönetim Objective: Isolated levocardia is a situs abnormality that the heart is Amaç: ‹zole levokardi, kalbin normal levo pozisyonunda oldu¤u in the normal levo position, but the abdominal viscera are in dextro fakat abdominal iç organlar›n dekstro pozisyonunda oldu¤u bir si- position. Most cases are accompanied by structural heart anomalies. tus anomalisidir. Ço¤u olguda yap›sal kalp anomalileri de efllik et- In this case, we aimed to present a fetus with isolated levocardia with- mektedir. Çal›flmam›zda, kardiyak anomalisi olmayan izole levo- out cardiac abnormality. kardili bir fetüsü sunmay› amaçlad›k. Case: The mother was referred to our clinic with a suspicion of fetal Olgu: Olgumuz, 22. gebelik haftas›nda fetal dekstrokardi flüphe- dextrocardia at 22 weeks of gestation. When detailed examination was siyle klini¤imize sevk edildi. Planlanan detayl› ultrason muayene- planned by ultrasonography isolated levocardia was detected in fetus. sinde, fetüste izole levokardi tespit edildi. Fetal ekokardiyografide There were no cardiac abnormalities in fetal echocardiography. Fetus hiçbir kardiyak anomali görülmedi.
    [Show full text]
  • Coronary Angiography in a Patient with Situs Inversus and Dextrocardia
    Case Reports Olgu Sunumlar› 455 Coronary angiography in a patient with situs inversus and dextrocardia Situs inversuslu¸ ve dekstrokardili bir hastada koroner anjiyografi Mehmet Çilingiro¤lu, Mohammad-Abdul Waheed, Nuri Akkufl Department of Interventional Cardiology, Faculty of Medicine, University of Cincinnati, Cincinnati, Ohio, USA Introduction Dextrocardia occurs rarely, with a frequency estimated at 1:10,000 (1). There is scant information available to the angiographer faced with performing catheterization in a patient with dextrocardia. We report successful coronary angiography in a patient with dextrocardia associated with situs inversus totalis. Catheterization in our patient was performed without difficulty using standard techniques. Case Report A 50-year old white male with known dextrocardia presented with severe substernal chest pains. His symptoms were reproducible with mild to moderate exertion. Physical examination was unremarkable except for findings consistent with dextrocardia. Chest X ray was remarkable for dextrocardia and right-sided stomach bubble. Electrocardiogram, with the properly reversed leads for dextrocardia, showed left ventricular hypertrophy. Two-dimensional echocardiogram Figure 1. Left ventricular angiogram taken in LAO view showed a left-sided liver and dextrocardia without other abnormalities. LAO-left anterior oblique Exercise testing using modified Bruce protocol reproduced his symptoms within the first stage of the test. Cardiac catheterization was performed from the right femoral artery. Catheters were passed using mirror-image angiographic angles. A 6-French angulated pigtail catheter was passed into left ventricle and a left ventriculogram was obtained using 30-degree left anterior oblique imaging (Fig. 1). Selective coronary angiogram was performed using left and right 6-French 4 cm Judkins diagnostic catheters (400 right anterior oblique) (Fig.
    [Show full text]
  • Factors Impacting Echocardiographic Imaging After the Fontan Procedure: a Report from the Pediatric Heart Network Fontan Cross- Sectional Study
    Children's Mercy Kansas City SHARE @ Children's Mercy Manuscripts, Articles, Book Chapters and Other Papers 10-1-2013 Factors impacting echocardiographic imaging after the Fontan procedure: a report from the pediatric heart network fontan cross- sectional study. Richard V. Williams Renee Margossian Minmin Lu Andrew M. Atz Timothy J. Bradley See next page for additional authors Follow this and additional works at: https://scholarlyexchange.childrensmercy.org/papers Part of the Cardiology Commons, Cardiovascular System Commons, Congenital, Hereditary, and Neonatal Diseases and Abnormalities Commons, Pediatrics Commons, and the Surgical Procedures, Operative Commons Recommended Citation Williams, R. V., Margossian, R., Lu, M., Atz, A. M., Bradley, T. J., Campbell, M. J., Colan, S. D., Gallagher, D., Lai, W. W., Pearson, G. D., Prakash, A., Shirali, G. S., Cohen, M. S., . Factors impacting echocardiographic imaging after the Fontan procedure: a report from the pediatric heart network fontan cross-sectional study. Echocardiography (Mount Kisco, N.Y.) 30, 1098-1106 (2013). This Article is brought to you for free and open access by SHARE @ Children's Mercy. It has been accepted for inclusion in Manuscripts, Articles, Book Chapters and Other Papers by an authorized administrator of SHARE @ Children's Mercy. For more information, please contact [email protected]. Creator(s) Richard V. Williams, Renee Margossian, Minmin Lu, Andrew M. Atz, Timothy J. Bradley, Michael Jay Campbell, Steven D. Colan, Dianne Gallagher, Wyman W. Lai, Gail D. Pearson, Ashwin Prakash, Girish S. Shirali, Meryl S. Cohen, and Pediatric Heart Network Investigators This article is available at SHARE @ Children's Mercy: https://scholarlyexchange.childrensmercy.org/papers/906 NIH Public Access Author Manuscript Echocardiography.
    [Show full text]
  • Pub 100-04 Medicare Claims Processing Centers for Medicare & Medicaid Services (CMS) Transmittal 3054 Date: August 29, 2014 Change Request 8803
    Department of Health & CMS Manual System Human Services (DHHS) Pub 100-04 Medicare Claims Processing Centers for Medicare & Medicaid Services (CMS) Transmittal 3054 Date: August 29, 2014 Change Request 8803 SUBJECT: Ventricular Assist Devices for Bridge-to-Transplant and Destination Therapy I. SUMMARY OF CHANGES: This Change Request (CR) is effective for claims with dates of service on and after October 30, 2013; contractors shall pay claims for Ventricular Assist Devices as destination therapy using the criteria in Pub. 100-03, part 1, section 20.9.1, and Pub. 100-04, Chapter 32, sec. 320. EFFECTIVE DATE: October 30, 2013 *Unless otherwise specified, the effective date is the date of service. IMPLEMENTATION DATE: September 30, 2014 Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. Any other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents. II. CHANGES IN MANUAL INSTRUCTIONS: (N/A if manual is not updated) R=REVISED, N=NEW, D=DELETED-Only One Per Row. R/N/D CHAPTER / SECTION / SUBSECTION / TITLE D 3/90.2.1/Artifiical Hearts and Related Devices R 32/Table of Contents N 32/320/Artificial Hearts and Related Devices N 32/320.1/Coding Requirements for Furnished Before May 1, 2008 N 32/320.2/Coding Requirements for Furnished After May 1, 2008 N 32/320.3/ Ventricular Assist Devices N 32/320.3.1/Postcardiotomy N 32/320.3.2/Bridge-To -Transplantation (BTT) N 32/320.3.3/Destination Therapy (DT) N 32/320.3.4/ Other N 32/320.4/ Replacement Accessories and Supplies for External Ventricular Assist Devices or Any Ventricular Assist Device (VAD) III.
    [Show full text]
  • Heterotaxy and Complex Structural Heart Defects in a Mutant Mouse Model of Primary Ciliary Dyskinesia
    Heterotaxy and complex structural heart defects in a mutant mouse model of primary ciliary dyskinesia Serena Y. Tan, … , Linda Leatherbury, Cecilia W. Lo J Clin Invest. 2007;117(12):3742-3752. https://doi.org/10.1172/JCI33284. Research Article Development Primary ciliary dyskinesia (PCD) is a genetically heterogeneous disorder associated with ciliary defects and situs inversus totalis, the complete mirror image reversal of internal organ situs (positioning). A variable incidence of heterotaxy, or irregular organ situs, also has been reported in PCD patients, but it is not known whether this is elicited by the PCD- causing genetic lesion. We studied a mouse model of PCD with a recessive mutation in Dnahc5, a dynein gene commonly mutated in PCD. Analysis of homozygous mutant embryos from 18 litters yielded 25% with normal organ situs, 35% with situs inversus totalis, and 40% with heterotaxy. Embryos with heterotaxy had complex structural heart defects that included discordant atrioventricular and ventricular outflow situs and atrial/pulmonary isomerisms. Variable combinations of a distinct set of cardiovascular anomalies were observed, including superior-inferior ventricles, great artery alignment defects, and interrupted inferior vena cava with azygos continuation. The surprisingly high incidence of heterotaxy led us to evaluate the diagnosis of PCD. PCD was confirmed by EM, which revealed missing outer dynein arms in the respiratory cilia. Ciliary dyskinesia was observed by videomicroscopy. These findings show that Dnahc5 is required for the specification of left-right asymmetry and suggest that the PCD-causing Dnahc5 mutation may also be associated with heterotaxy. Find the latest version: https://jci.me/33284/pdf Research article Heterotaxy and complex structural heart defects in a mutant mouse model of primary ciliary dyskinesia Serena Y.
    [Show full text]
  • Atrial Septal Stenting to Increase Interatrial Shunting in Cyanotic Congenital Heart Diseases: a Report of Two Cases
    422 Türk Kardiyol Dern Arş - Arch Turk Soc Cardiol 2011;39(5):422-426 doi: 10.5543/tkda.2011.01368 Atrial septal stenting to increase interatrial shunting in cyanotic congenital heart diseases: a report of two cases Siyanotik doğuştan kalp hastalıklarında interatriyal şantı artırmak amacıyla atriyal septuma stent uygulaması: İki olgu sunumu Yalım Yalçın, M.D., Cenap Zeybek, M.D.,§ İbrahim Özgür Önsel, M.D.,# Mehmet Salih Bilal, M.D.† Departments of Pediatric Cardiology, #Anesthesiology and Reanimation, and †Cardiovascular Surgery, Medicana International Hospital; §Department of Pediatric Cardiology, Şişli Florence Nightingale Hospital, İstanbul Summary – Aiming to increase mixing at the atrial level, Özet – Siyanotik doğuştan kalp hastalığı tanısıyla izle- atrial septal stenting was performed in two pediatric nen iki bebekte, atriyal düzeyde karışımı artırmak ama- cases with cyanotic congenital cardiac diseases. The cıyla atriyal septuma stent yerleştirme işlemi uygulandı. first case was a 3-month-old male infant with transpo- Birinci olgu, büyük arterlerin transpozisyonu tanısıyla sition of the great arteries. The second case was an izlenen üç aylık bir erkek bebekti. Diğer olgu, ameliyat 18-month-old male infant with increased central venous sonrası dönemde sağ ventrikül çıkım yolu tıkanıklığına pressure due to postoperative right ventricular outflow bağlı olarak santral venöz basınç yüksekliği gelişen 18 tract obstruction. Premounted bare stents of 8 mm in aylık bir erkek bebekti. Her iki olguda da 8 mm çapında, diameter were used in both cases. The length of the balona monte edilmiş çıplak stent kullanıldı. Stent uzun- stent was 20 mm in the first case and 30 mm in the lat- luğu ilk olguda 20 mm, ikinci olguda 30 mm idi.
    [Show full text]
  • Situs Inversus Totalis - a Case Report
    IOSR Journal of Applied Physics (IOSR-JAP) e-ISSN: 2278-4861. Volume 3, Issue 6 (May. - Jun. 2013), PP 12-16 www.iosrjournals.org Situs Inversus Totalis - A Case Report *Dr. G.Supriya,** Dr. S.Saritha, **Dr. Seema Madan *Assistant professor, ** Professor of Anatomy, GMC, Secunderabad Abstract: SITUS INVERSUS TOTALIS is a congenital positional anomaly characterized by transposition of abdominal viscera associated with a right sided heart (Dextrocardia) .It was Mathew Baillie who first described situs inversus totalis in early twentieth century. A transposed thoracic and abdominal organ is a mirror image of the normal anatomy when examined or visualized by tests such as x-ray filming. The term situs inversus is a short form of the Latin meaning inverted position of the internal organs. Generally individuals with situs inversus totalis are asymptomatic and have a normal life expectancy. Many people with situs inversus totalis are unaware of their unusual anatomy until they seek medical attention for an unrelated condition. The reversal of the organs may lead to some confusion as many signs and symptoms will be on the reverse side. A 27 years old male patient reported to the Department of Nephrology with the c/o left sided flank pain since 1 week. The Chest X-ray, Ultrasonography, CT scan and MRI were done and he was diagnosed as SITUS INVERSUS TOTALIS. The anatomic, pathologic, embryologic and etiology of complete Situs inversus and related abnormalities are presented in this case with special emphasis to genetic correlation. Key words: Situs inversus totalis, Dextrocardia, Congenital, Transposition, Thoracic and abdominal organs. I.
    [Show full text]
  • From the Left to the Right a Tale of Asymmetries, Environments, and Hippocampal Development
    From the left to the right A tale of asymmetries, environments, and hippocampal development by Matthew Case June, 2018 A thesis presented to the Graduate School of the Institute of Science and Technology Austria, Klosterneuburg, Austria in partial fulfilment of the requirements for the degree of Doctor of Philosophy The dissertation of Matthew Case, titled ‘From the left to the right: A tale of asymmetries, environments, and hippocampal development’, is approved by: Supervisor: [Name of Supervisor], IST Austria, Klosterneuburg, Austria Signature: Committee Member: [Name of Committee Member], IST Austria, Klosterneuburg, Austria Signature: Committee Member: [Name of Committee Member], [Institute], [City], [Country] Signature: Exam Chair: [Name of Exam Chair], IST Austria, Klosterneuburg, Austria Signature: © by Matthew Case, June, 2018 All Rights Reserved I hereby declare that this dissertation is my own work and that it does not contain other people’s work without this being so stated; this thesis does not contain my previous work without this being stated, and the bibliography contains all the literature that I used in writing the dissertation. I declare that this is a true copy of my thesis, including any final revisions, as approved by my thesis committee, and that this thesis has not been submitted for a higher degree to any other university or institution. I certify that any republication of materials presented in this thesis has been approved by the relevant publishers and co-authors. Signature: _______________________ [Matthew J Case] June 27, 2018 “Symmetry is what we see at a glance; based on the fact that there is no reason for any difference...” ― Blaise Pascal, Pensées Dedication I'd like to offer a joint dedication for this thesis.
    [Show full text]
  • Asymmetry Inside the Symmetry: Mechanisms and Disorders of Laterality
    Asymmetry Inside The Symmetry: Mechanisms and Disorders Of Laterality Yasemin ALANAY1, Ersin GÜMÜŞ2, Miray SEKKİN2, Sebile GÜLER2, A. Nur ÇAKAR3 Ankara-Turkey Asy mmetry of the left-right (L-R) axis is a feature of vertebrates that is apparent in the viscera and vas- culature. An understanding of L-R patterning in human development is aided by familiarity with key ev ents and important pathways in mammalian embryogenesis.The induction of L-R asymmetry follows the establishment of the anteroposterior (A-P or rostrocaudal) and dorsoventral (D-V) axes and re- quires the pre-existing midline symmetry to be broken before sidedness is induced via a series of complex, coordinated molecular signaling events. In this review, our aim is to describe the molecular background of this embryological process, and giv e brief knowledge concerning its clinical conse- quences. (Gynecol Obstet Reprod Med 2006; 12:000-000) Key Words: Heterotaxy, Laterality, Situs anomalies Many living creatures in nature, from Ascidians to man, T here are also many l ess defin ed asymmetries that hav e exhibit symmetry which can be described as correspondence been the focus of many studies to date. Human hand prefe- in size, shape and relative position of congruent components rence and the functional asymmetry of the brain hemispheres are still attractive research areas, and the basics of genetic about a plane or axis, as a feature of their external body plan. 1 Most animals possess symmetrical body plans such as; sphe- mechanisms are still controversial. Cell mediated immune 2 rical, radial, chiral, bilateral and pseudo-bilateral. In har- hypersensitivity is stronger on the left side of the body and mony with this, possession of a symmetrical body plan is the left side of the scrotum descends lower than the right in 3 one of the conspicuous morphological characteristics of ver- correlation with handedness.
    [Show full text]