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lüll Fetal echocardiographic evaluation of atrial morphology and the prediction of laterality in cases of heterotaxy syndromes Berg C; Geipel A; Kohl T; Smrcek J; Germer U; Baschat AA; Hansmann M; Gembruch UUltrasound Obstet Gynecol 2005[Oct]; 26 (5): 538-45OBJECTIVE: To evaluate whether abnormal atrial morphology, which is well recognized in autopsy series, is detectable by fetal echocardiographic examination of the four-chamber view, and can therefore be utilized to differentiate left from right isomerism in heterotaxy syndromes. METHODS: This study was a retrospective review of 30 cases with prenatally diagnosed heterotaxy syndromes. Ultrasound video recordings and still images were reviewed with respect to atrial morphology in the four-chamber view. In 25 cases the morphology of both atria was sufficiently well visualized on the recordings to be evaluated and only these were included in the study. RESULTS: Two types of atrial morphology were distinguished in our cohort: a sickle-shape with the tip pointing laterally and apically, and a blunt shape resembling the usual atrial appearance in the four-chamber view. Nineteen out of the 25 cases (76%) presented with isomerism of the atria in the four-chamber view. Thirteen had bilateral sickle-shaped atrial morphology, all associated with left isomerism. Six had bilateral blunt-shaped atrial morphology, all associated with right isomerism. The atria of the remaining six cases were not isomeric, the right atrium being sickle-shaped and the left blunt-shaped. Five of the latter cases were associated with left and one with right isomerism. CONCLUSIONS: The majority of prenatally diagnosed heterotaxy syndromes seem to present with isomeric atrial morphology in the four-chamber view. In these cases a differentiation between left and right isomerism can be based on the two distinct types of atrial morphology. This may further enhance the prenatal differentiation of these syndromes.|Chi-Square Distribution[MESH]|Echocardiography/*methods[MESH]|Female[MESH]|Heart Atria/diagnostic imaging/embryology[MESH]|Heart Defects, Congenital/*diagnostic imaging/embryology[MESH]|Humans[MESH]|Infant, Newborn[MESH]|Predictive Value of Tests[MESH]|Pregnancy[MESH]|Retrospective Studies[MESH]|Syndrome[MESH]|Ultrasonography, Prenatal/*methods[MESH] |