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Ann Thorac Surg 1983;35:400-405
© 1983 The Society of Thoracic Surgeons

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Articles

Right and Left Isomerism: The Cardiac Surgeon's View

From the Departments of General Surgery, Sections of Pediatric Cardiac Surgery, Pediatric Cardiology, Anesthesiology, and Pathology, University of Amsterdam, Amsterdam, The Netherlands

Accepted for publication April 12, 1982.

^* Address reprint requests to Dr. Marcelletti, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

We have treated by palliative or corrective surgery 12 patients with the complex cardiovascular anomalies associated with right isomerism (asplenia syndrome) or left isomerism (polysplenia syndrome). A systemic-pulmonary artery shunt was performed in 4 patients, with 2 early deaths. Anatomical intracardiac repair was successfully done in 2 patients, while an orthoterminal repair using a modified Fontan procedure was attempted in 5 patients, only 1 of whom survived. A 1-year-old girl with diffuse pulmonary arteriovenous fistulas associated with left isomerism was not considered a good candidate for operation after an exploratory sternotomy. The surgical options and technical problems related to the complex intracardiac morphology of these developmental syndromes are presented.

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