Structure and torsion of the normal and situs inversus totalis cardiac left ventricle. I. Experimental data in humans

2008 ◽  
Vol 295 (1) ◽  
pp. H197-H201 ◽  
Author(s):  
Tammo Delhaas ◽  
Wilco Kroon ◽  
Wim Decaluwe ◽  
Mirjam Rubbens ◽  
Peter Bovendeerd ◽  
...  
Keyword(s):  
Situs Inversus ◽  
Mechanical Load ◽  
Normal Structure ◽  
Companion Paper ◽  
Situs Inversus Totalis ◽  
Left Ventricular ◽  
Mirror Image ◽  
Anatomical Structures ◽  
Magnetic Resonance Tagging ◽  
Cardiac Left Ventricle

In 1926, the famous American pediatric cardiologist, Dr. Helen B. Taussig, observed that in situs inversus totalis (SIT) main gross anatomical structures and the deep muscle bundles of the ventricles were a mirror image of the normal structure, while the direction of the superficial muscle bundles remained unchanged (H. B. Taussig, Bull Johns Hopkins Hosp 39: 199–202, 1926). She and we wondered about the implication of this observation for left ventricular (LV) deformation in SIT. We used magnetic resonance tagging to obtain information on LV deformation, rotation, and torsion from a series of tagged images in five evenly distributed, parallel, short-axis sections of the heart of nine controls and eight persons with SIT without other structural (cardiac) defect. In the controls, during ejection, the apex rotated counterclockwise with respect to the base, when looking from the apex. Furthermore, the base-to-apex gradient in rotation (torsion) was negative and similar at all longitudinal levels of the LV. In SIT hearts, torsion was positive near the base, indicating mirrored myofiber orientations compared with the normal LV. Contrary to expectations, torsion in the apical regions of SIT LVs was as in normal ones, reflecting a normal internal myocardial architecture. The transition zone with zero torsion, found between the apex and base, suggests that the heart structure in SIT is essentially different from that in the normal heart. This provides a unique possibility to study regulatory mechanisms for myocardial fiber orientation and mechanical load, which has been dealt with in the companion paper by Kroon et al.

Structure and torsion in the normal and situs inversus totalis cardiac left ventricle. II. Modeling cardiac adaptation to mechanical load

2008 ◽  
Vol 295 (1) ◽  
pp. H202-H210 ◽  
Author(s):  
Wilco Kroon ◽  
Tammo Delhaas ◽  
Peter Bovendeerd ◽  
Theo Arts
Keyword(s):  
Left Ventricle ◽  
Situs Inversus ◽  
Mechanical Load ◽  
Systolic Pressure ◽  
Situs Inversus Totalis ◽  
Cardiac Structure ◽  
Mechanical Stimuli ◽  
Model Study ◽  
Cardiac Adaptation ◽  
Cardiac Left Ventricle

Mathematical models provide a suitable platform to test hypotheses on the relation between local mechanical stimuli and responses to cardiac structure and geometry. In the present model study, we tested hypothesized mechanical stimuli and responses in cardiac adaptation to mechanical load on their ability to estimate a realistic myocardial structure of the normal and situs inversus totalis (SIT) left ventricle (LV). In a cylindrical model of the LV, 1) mass was adapted in response to myofiber strain at the beginning of ejection and to global contractility (average systolic pressure), 2) cavity volume was adapted in response to fiber strain during ejection, and 3) myofiber orientations were adapted in response to myofiber strain during ejection and local misalignment between neighboring tissue parts. The model was able to generate a realistic normal LV geometry and structure. In addition, the model was also able to simulate the instigating situation in the rare SIT LV with opposite torsion and transmural courses in myofiber direction between the apex and base [Delhaas et al. ( 6 )]. These results substantiate the importance of mechanical load in the formation and maintenance of cardiac structure and geometry. Furthermore, in the model, adapted myocardial architecture was found to be insensitive to fiber misalignment in the transmural direction, i.e., myofiber strain during ejection was sufficient to generate a realistic transmural variation in myofiber orientation. In addition, the model estimates that, despite differences in structure, global pump work and the mass of the normal and SIT LV are similar.

Assessment and comparison of left ventricular shear in normal and situs inversus totalis hearts by means of magnetic resonance tagging

2015 ◽  
Vol 308 (5) ◽  
pp. H416-H423 ◽  
Author(s):  
Alessandro C. Rossi ◽  
Marieke Pluijmert ◽  
Peter H. M. Bovendeerd ◽  
Wilco Kroon ◽  
Theo Arts ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Situs Inversus ◽  
Linear Trend ◽  
Human Subjects ◽  
Situs Inversus Totalis ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Significant Difference ◽  
Magnetic Resonance Tagging ◽  
Myocardial Structure

Situs inversus totalis (SIT) is characterized by complete mirroring of gross cardiac anatomy and position combined with an incompletely mirrored myofiber arrangement, being normal at the apex but inverted at the base of the left ventricle (LV). This study relates myocardial structure to mechanical function by analyzing and comparing myocardial deformation patterns of normal and SIT subjects, focusing especially on circumferential-radial shear. In nine control and nine SIT normotensive human subjects, myocardial deformation was assessed from magnetic resonance tagging (MRT) image sequences of five LV short-axis slices. During ejection, no significant difference in either circumferential shortening (εcc) or its axial gradient (Δεcc) is found between corresponding LV levels in control and SIT hearts. Circumferential-radial shear (εcr) has a clear linear trend from apex-to-base in controls, while in SIT it hovers close to zero at all levels. Torsion as well as axial change in εcr (Δεcr) is as in controls in apical sections of SIT hearts but deviates significantly towards the base, changing sign close to the LV equator. Interindividual variability in torsion and Δεcr values is higher in SIT than in controls. Apex-to-base trends of torsion and Δεcr in SIT, changing sign near the LV equator, further substantiate a structural transition in myofiber arrangement close to the LV equator itself. Invariance of εcc and Δεcc patterns between controls and SIT subjects shows that normal LV pump function is achieved in SIT despite partial mirroring of myocardial structure leading to torsional and shear patterns that are far from normality.

Situs Inversus Totalis

2001 ◽  
Vol 20 (1) ◽  
pp. 63-67 ◽  
Author(s):  
Janie Spoon
Keyword(s):  
Situs Inversus ◽  
Vena Cava ◽  
Situs Inversus Totalis ◽  
Mirror Image ◽  
The Body ◽  
Radiographic Examination ◽  
Internal Organs ◽  
Radiographic Findings ◽  
Situs Solitus ◽  
The Right

EXTERNALLY, THE HUMAN BODY appears symmetric; if a line is drawn down the middle of the body, each side appears identical. However, this is not true of the internal anatomy. For example, there is one heart, which lies in the left chest, one liver, in the right abdomen, and one stomach, in the left abdomen. The term situs refers to the position or location of an organ, specifically, the position of the atria and abdominal viscera in relation to the midline of the body.1 There are three types of situs: solitus, inversus, and ambiguous. Situs solitus refers to the normal arrangement of organs, with the right atrium, liver, gallbladder, trilobed lung, and inferior vena cava on the right side and the left atrium, stomach, spleen, bilobed lung, and descending aorta on the left side (Figures 1–3). Situs inversus totalis refers to a mirror image reversal of the normal position of the internal organs (Figures 4 and 5). 1 The incidence of situs inversus totalis is 1 in every 8,000 to 25,000 births, and the condition is most often diagnosed by radiographic examination.2Situs ambiguous, often referred to as heterotaxia, is the random arrangement of the internal organs and is associated with splenic abnormalities and congenital heart disease.3 The purpose of this column is to discuss the embryology, pathophysiology, and diagnosis of situs inversus totalis and to review a case study with radiographic findings.

scholarly journals Specificities of transplantation of kidneys procured from donors with situs inversus totalis: A case report and review of the literature

2015 ◽  
Vol 72 (1) ◽  
pp. 63-67 ◽  
Author(s):  
Milica Petrovic ◽  
Violeta Rabrenovic ◽  
Dusica Stamenkovic ◽  
Neven Vavic ◽  
Zoran Kovacevic ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Case Report ◽  
Situs Inversus ◽  
Iliac Fossa ◽  
Preoperative Evaluation ◽  
Situs Inversus Totalis ◽  
Mirror Image ◽  
Image Reversal ◽  
The Right

Introduction. Situs inversus totalis (SIT) represents a total vertical transposition of the thoracic and abdominal organs which are arranged in a mirror image reversal of the normal positioning 1. We presented a successful pre-dialysis kidney transplantation from a living sibling donor with SIT and the longest donor follow-up period, along with analysis of the reviewed literature. Case report. The pair for pre-dialysis kidney transplantation included a 68-year-old mother and 34-year-old daughter at low immunological risk. Comorbidities evidenced in kidney donors with previously diagnosed SIT, included moderate arterial hypertension and borderline blood glucose level. Explantation of the left donor kidney and its placement into the right iliac fossa of the recipient were performed in the course of the surgical procedure. A month after nephrectomy, second degree renal failure was noticed in the donor. A 20-month follow-up of the donor?s kidney and graft in the recipient proved that their functions were excellent. Conclusion. In donors with previously diagnosed SIT the multidisciplinary approach, preoperative evaluation of the patient and detection of possible vascular anomalies are required to provide maximum safety for the donor.

scholarly journals Implantation of a CRT-D in a Patient with Dextrocardia and Situs Inversus Totalis, Who Has Persistent Left Ventricular Dysfunction with VT/VF

2011 ◽  
Vol 27 (Supplement) ◽  
pp. PJ1_086
Author(s):  
Takeshi Nagata ◽  
Yoshihiro Yamada ◽  
Takashi Kudo ◽  
Yoshinori Nakamura ◽  
Yuji Ogura ◽  
...  
Keyword(s):  
Left Ventricular Dysfunction ◽  
Situs Inversus ◽  
Ventricular Dysfunction ◽  
Situs Inversus Totalis ◽  
Left Ventricular

scholarly journals Emergency mitral valve replacement in dextrocardia with situs inversus totalis: Surgeon's dilemma of mirror image

2021 ◽  
Vol 5 (1) ◽  
pp. 19
Author(s):  
Anshuman Darbari ◽  
Devender Singh ◽  
PrashantL Patil ◽  
Barun Kumar
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Situs Inversus ◽  
Situs Inversus Totalis ◽  
Mirror Image

scholarly journals Right Hemihepatectomy via an Anterior Approach for Hepatocellular Carcinoma in a Situs Inversus Totalis Patient

2020 ◽  
Vol 14 (1) ◽  
pp. 91-97
Author(s):  
Rong-Dang Fu ◽  
Jie-Yuan Li ◽  
Xiao-Hong Zhang ◽  
Huan-Wei Chen
Keyword(s):  
Hepatocellular Carcinoma ◽  
Situs Inversus ◽  
Anterior Approach ◽  
Middle Hepatic Vein ◽  
Situs Inversus Totalis ◽  
Mirror Image ◽  
Right Hemihepatectomy ◽  
Glissonian Approach ◽  
Congenital Condition ◽  
Chest X Ray

Situs inversus totalis (SIT) is a rare congenital condition in which the usual position of the organs is reversed from left to right as a mirror image of the normal situation. Due to the abnormal transposition, this represents a technical challenge for the surgeon. In the present study, right hemihepatectomy via the anterior approach was performed for a 68-year-old hepatocellular carcinoma (HCC) patient with SIT. SIT was diagnosed by chest X-ray and computed tomography. The tumors were located in segments VIII and VI of the liver, and there was no metastasis to the lymph nodes and distant organs. Hemihepatic vascular inflow occlusion was performed using the selective intra-Glissonian approach. The middle hepatic vein was preserved under the guidance with intraoperative ultrasonography. The present case suggests that right hemihepatectomy via the anterior approach may be a safe, feasible, and effective procedure for HCC patients with SIT.

Situs Inversus Totalis: Operating on the Mirror Image

2020 ◽  
Vol 92 (3-4) ◽  
pp. 150-152
Author(s):  
Avijit Roy ◽  
Madhumita Mukhopadhyay
Keyword(s):  
Situs Inversus ◽  
Situs Inversus Totalis ◽  
Mirror Image
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