Cardiac malpositions

Cardiac malposition refers to any position of the heart other than a left-sided heart in a situs solitus individual. Associated cardiac malformations are so complex that even angiocardiographic and autopsy studies maynot afford an accurate information. Although the terms and classifications used to describe the internal cardiacanotomy and their arterial connections in cardiac malpositions differ and tend to be confusing, common agreement exists on the need for a segmental approach to diagnosis. Authors present 18 cases or cardiac malpostions in which cardiac catheterization and angiocardiography were done at the Department of Radiology, Seoul National University Hospital between 1971 and 1979. Authors analized the clinical, radiographic, operative and autopsy findings with the emphasis on the angiocardiographic findings. The reuslts are as follows; 1. Among 18 cases with cardiacmal positions, 6 cases had dextrocardia with situs inversus, 9 cases had dextrocardia with situs solitus and 3 cases had levocardia with situs inversus. 2. There was no genuine exception to visceroatrial concordance rule. 3. Associated cardiac malformations were variable and complex with a tendency of high association of transposition and double outlet varietis with dextrocardia in situs solitus and levocardia in situs inversus. Only one in 6 cases of dextrocardia with situs inversus had pure transposition. 4. In two cases associated pulmonary atresia was found at surgery which was not predicted by angiocardiography. 5. Because many of the associated complex lesionscan be corrected surgically provided the diagnosis is accurate, the selective biplane angiocardiography with or without cineradiography is essential.