Andersons pediatric cardiology 1309
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JuxtapositionoftheAtrialAppendages
Juxtapositionoftheatrialappendagesisapotentiallyconfusingfeatureofa
congenitallymalformedheart.Inthenormallyconstructedheart,theappendages
lieonetoeachsideofthearterialpedicle.Itisthemorphologicnatureofeach
appendagethatdeterminesthearrangementoftheatrialchambers(seeChapter
1).Juxtapositionoftheappendagesisseenwhenboththeappendagesaretothe
samesideofthearterialpedicle.Suchjuxtapositiondoesnotinterferewith
recognitionofthestructureofeachappendage,sincethisfeatureisassessedon
thebasisoftheextentofthepectinatemuscles.Thereforejuxtapositioncan
occurinthepersonwiththeusualatrialarrangement(Fig.49.9),inthe
individualwithamirror-imagedarrangement,orinthepresenceofisomeric
appendages(Fig.49.10).Inthepresenceoftheusualatrialarrangement,
juxtapositionoccursmostfrequentlywhentherightappendageisdeviated
leftwardthroughthetransversesinussothatitliesabovetheleftappendage
(Figs.49.11and49.12,seealsoFig.49.9).Thisisconventionallycalledleft
juxtaposition.Ittendstobeassociatedwithrelativelycomplexanatomiclesions.
Noteworthyassociatedmalformationsaretricuspidatresia,hypoplasiaofthe
rightventricle,andabnormalventriculoarterialconnections,23suchasdoubleoutletrightventricle.
FIG.49.9 Reconstructionmadefromacomputedtomographicdataset
preparedfromapatientwithconcordantatrioventricularconnectionsand
double-outletrightventricleshowsthearrangementinwhichbothatrial
appendagesaretotheleftofthearterialpedicle.Thisisleft-sided
juxtaposition,albeitthattheappendagesarestillrecognizedasbeing
morphologicallyright(RAA)andmorphologicallyleft(LAA).Ao,Aorta;LV,
leftventricle;PT,pulmonarytrunk;RV,rightventricle.
FIG.49.10 Inthiscomputedtomographicdataset,preparedfromapatient
withatopsy-turvyheart,boththeappendagesaretotherightofthearterial
pedicle.Thisisright-sidedjuxtaposition,buttheappendagescanbe
recognizedasbeingmorphologicallyright(RAA)andmorphologicallyleft
(LAA).Ao,Aorta;ICV,inferiorcavalvein;LA,leftatrium;LV,leftventricle;
PT,pulmonarytrunk;RV,rightventricle.
