This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Araoz, P. A. Articles by Higgins, C. B. Search for Related Content PubMed PubMed Citation Articles by Araoz, P. A. Articles by Higgins, C. B.

(Circulation. 2002;105:537.)
© 2002 American Heart Association, Inc.

Images in Cardiovascular Medicine

Magnetic Resonance Angiography of Criss-Cross Heart

Philip A. Araoz, MD; Gautham P. Reddy, MD; Pate D. Thomson, MD; Charles B. Higgins, MD

From the Department of Radiology, University of California, San Francisco (P.A.A., G.P.R., C.B.H.); and the Berkeley Cardiovascular Group (P.D.T.), Berkeley, Calif.

Correspondence to Charles B. Higgins, MD, Department of Radiology, University of California, San Francisco, Box 0628, Suite L308, 505 Parnassus Avenue, San Francisco, CA 94143. E-mail charles.higgins@radiology.ucsf.edu

A 29-year-old man presented with a history of cyanotic congenital heart disease. During childhood, cardiac catheterization and angiography had demonstrated atrial situs solitus, L-ventricular loop, L-transposition of the great arteries, and criss-cross atrioventricular connections. The patient had a Mustard procedure at age 13 that improved the cyanosis. He was now reporting decreasing exercise tolerance.

The patient underwent cardiac MRI with magnetic resonance angiography (MRA) as the first step in his evaluation. MRI showed L-transposition of the great arteries and an L-ventricular loop (inversion of the ventricles). The ventricles also had a superior/inferior relationship, in which the morphological right ventricle was to the left of and superior to the morphological left ventricle (Figure 1). The atria were normally positioned (atrial situs solitus), and the atrioventricular connections were concordant. The concordant atrioventricular connections occurred because the pulmonic and systemic blood streams crossed in the midheart, so that the normally positioned atria supplied the appropriate but abnormally positioned ventricles. This type of atrioventricular relation-ship has been called the "criss-cross heart," or "twisted atrioventricular connection."

View larger version (142K): [in this window] [in a new window]   Figure 1. Volume-rendered, 3D reconstruction of gadolinium-enhanced MRA. The projection is equivalent to a right anterior oblique view in conventional angiography. The morphological right ventricle (RV) is superior and to the left of the morphological left ventricle (LV). Note the infundibulum (arrow) and trabeculations that define the morphological right ventricle. The right atrium (RA) attaches to the right ventricle via a long, superior connection that crosses over the left atrium-to-left ventricle connection. Ventriculoarterial connections are . . . [Full Text of this Article]

This article has been cited by other articles:

				O. K. Mohrs, S. E. Petersen, T. Voigtlaender, J. Peters, B. Nowak, M. K. Heinemann, and H.-U. Kauczor Time-Resolved Contrast-Enhanced MR Angiography of the Thorax in Adults with Congenital Heart Disease Am. J. Roentgenol., October 1, 2006; 187(4): 1107 - 1114. [Abstract] [Full Text] [PDF]

				D. J. Pennell, U. P. Sechtem, C. B. Higgins, W. J. Manning, G. M. Pohost, F. E. Rademakers, A. C. van Rossum, L. J. Shaw, and E. K. Yucel Clinical indications for cardiovascular magnetic resonance (CMR): Consensus Panel report Eur. Heart J., November 1, 2004; 25(21): 1940 - 1965. [Full Text] [PDF]

				B. Marino and F. Mileto Criss-Cross Heart With D-Ventricular Loop Circulation, December 17, 2002; 106 (25): e223 - e223. [Full Text] [PDF]

				J. C. Nielsen and I. A. Parness Anatomy of a Criss-Cross Heart Circulation, August 27, 2002; 106 (9): e41 - e41. [Full Text] [PDF]