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Analysis of outcomes in patients with abnormal laterality undergoing congenital heart surgery

Part of: Cardiac Morphology

Published online by Cambridge University Press:  01 October 2021

Serdar Basgoze Open the ORCID record for Serdar Basgoze [Opens in a new window] ,
Bahar Temur ,
Osman Guvenc ,
Selim Aydin ,
Fusun Guzelmeric ,
Mehmet A. Onalan Open the ORCID record for Mehmet A. Onalan [Opens in a new window]  and
Ersin Erek
Serdar Basgoze*
Affiliation:
Department of Cardiovascular Surgery, Faculty of Medicine, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, İstanbul, Turkey
Bahar Temur
Affiliation:
Department of Cardiovascular Surgery, Faculty of Medicine, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, İstanbul, Turkey
Osman Guvenc
Affiliation:
Department of Pediatric Cardiology, Faculty of Medicine, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, İstanbul, Turkey
Selim Aydin
Affiliation:
Department of Cardiovascular Surgery, Faculty of Medicine, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, İstanbul, Turkey
Fusun Guzelmeric
Affiliation:
Department of Anesthesiology, Faculty of Medicine, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, İstanbul, Turkey
Mehmet A. Onalan
Affiliation:
Department of Cardiovascular Surgery, Faculty of Medicine, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, İstanbul, Turkey
Ersin Erek
Affiliation:
Department of Cardiovascular Surgery, Faculty of Medicine, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, İstanbul, Turkey
*
Author for correspondence: S. Basgoze, MD, Department of Pediatric Cardiac Surgery, Faculty of Medicine, Acibadem Mehmet Ali Aydinlar University, 34303 Halkali, Istanbul, Turkey. Tel: +90 533 626 03 50; +90 212 404 41 77. E-mail: basgozeserdar@gmail.com
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Abstract

Objective:

Laterality anomalies are almost always associated with severe cardiac anomalies. Demographic properties, type of the procedures, associated anomalies, and early and mid-term prognosis of four types of laterality anomalies were analysed.

Methods:

A total of 64 consecutive patients with laterality anomalies were enrolled between July 2014 and July 2020. We grouped the patients as situs solitus dextrocardia (SSD) (n = 12; 18.7%); situs inversus (SI) (n = 16; 25%); right atrial isomerism (RAI) (n = 29; 45.3%); and left atrial isomerism (LAI) (n = 7; 10.9%). TAPVC was only present in the RAI group (31%). Incidence of mitral or tricuspid atresia was higher in the SSD group (25%). All the patients were followed up with a mean of 19.06 ± 17.6 (0.1–72) months.

Results:

Early postoperative mortality was 17 patients, among 107 procedures (15.8%). Twelve patients were in the neonatal period. All ten patients survived after isolated ductal stenting. Fourteen of the deaths were in the RAI group (48.3%). The 3-year survival rates were 85% in LAI, 78.7% in SI, 55.8% in SSD, and 38% in RAI groups. According to the multivariable Cox regression model, mechanical ventilation, kidney injury, RAI, and complex surgery in the neonatal period were independent risk factors for early mortality.

Conclusion:

Laterality anomalies are one of the most challenging patients who commonly had univentricular physiology. The most prevalent anomaly was RAI, and RAI had the worst outcome and survival. Ductal stent is an acceptable first intervention during the neonatal period in suitable patients. Complex procedures may carry a high risk of death in the neonatal period.

Keywords

Abnormal lateralityheterotaxy syndromecongenital heart diseaseisomerismdextrocardia
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 7 , July 2022 , pp. 1129 - 1135
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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