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Surgical Management of Hearts with Isomeric Atrial Appendages
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  • Ujjwal Chowdhury,
  • Robert Anderson,
  • Diane E. Spicer,
  • Lakshmi Sankhyan,
  • Niraj Pandey,
  • Shikha Goja,
  • Palleti Rajashekar,
  • Balaji Arvind,
  • Doniparthi Pradeep
Ujjwal Chowdhury
All India Institute of Medical Sciences Cardio-Thoracic Sciences Centre
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Robert Anderson
Newcastle University
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Diane E. Spicer
Johns Hopkins All Children's Hospital Heart Institute
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Lakshmi Sankhyan
Department of Cardiothoracic Surgery All India Institute of Medical Sciences Bilaspur Himachal Pradesh
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Niraj Pandey
All India Institute of Medical Sciences Cardio-Thoracic Sciences Centre
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Shikha Goja
All India Institute of Medical Sciences Cardio-Thoracic Sciences Centre
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Palleti Rajashekar
All India Institute of Medical Sciences Cardio-Thoracic Sciences Centre
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Balaji Arvind
All India Institute of Medical Sciences Cardio-Thoracic Sciences Centre
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Doniparthi Pradeep
All India Institute of Medical Sciences Cardio-Thoracic Sciences Centre
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Abstract

Background and aim: On the basis of previously published accounts, coupled with our own experience, we have assessed the surgical approaches to patients with isomeric atrial appendages. Methods: We reviewed pertinent published studies on surgical treatment of individuals with isomeric atrial appendages, with the pertinent surgical details provided by most of the manuscripts. Results: Half of patients with right isomerism, and two-thirds of those with left isomerism have bilateral superior caval veins. Azygos extension of the inferior caval vein is reported in three-quarters of those with left isomerism. The coronary sinus is universally absent in right isomerism, along with totally anomalous pulmonary venous connection, and is absent in two-fifths of those with left isomerism.. Univentricular atrioventricular connections are expected in up to three-quarters of those with right isomerism. Atrioventricular septal defect is reported in up to four-fifths, more frequently in right isomerism, with such patients typically having discordant ventriculoatrial connections or double outlet right ventricle. Reported mortalities extend to 85% for those with right, and 50% for those with left isomerism. In right isomerism, mortality is up to 54% for systemic-to-pulmonary arterial shunting, up to 75% for univentricular repair, and up to 95% for repair of totally anomalous pulmonary venous connection itself. No more than one-quarter had undergone Fontan completion, with reported mortalities of 21%. Conclusion: Early surgical results are satisfactory in patients with left isomerism, but disappointing for those with right. Recent advances in cardiac and liver transplantation may offer improved survival.
03 Jan 2022Submitted to Journal of Cardiac Surgery
03 Jan 2022Assigned to Editor
03 Jan 2022Submission Checks Completed
03 Jan 2022Review(s) Completed, Editorial Evaluation Pending
03 Jan 2022Editorial Decision: Accept
May 2022Published in Journal of Cardiac Surgery volume 37 issue 5 on pages 1340-1352. 10.1111/jocs.16268