JTCS Medtronic Endurant
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Emin Tireli
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Sayin, O. A.
Right arrow Articles by Tireli, E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Sayin, O. A.
Right arrow Articles by Tireli, E.
Related Collections
Right arrow Cardiac - other
Right arrow Congenital - acyanotic

J Thorac Cardiovasc Surg 2006;131:474-475
© 2006 The American Association for Thoracic Surgery

Brief Communication

Bifid cardiac apex: A rare morphologic structure

Omer Ali Sayin, MD a , * , Murat Ugurlucan, MD a , Memduh Dursun, MD b , Adem Ucar, MD b , Emin Tireli, MD a

a Department of Cardiovascular Surgery, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
b Department of Radiology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey

Received for publication September 28, 2005; accepted for publication October 10, 2005.

* Address for reprints: Omer Ali Sayin, MD, Istanbul University, Istanbul Medical Faculty, Department of Cardiovascular Surgery, Millet Caddesi, 34390 Capa/Fatih, Istanbul, Turkey (Email: oasayin{at}hotmail.com).


Figure 1
M. Ugurlucan, E. Tireli, O. Sayin (left to right)


A 17-year-old patient was diagnosed with a large ventricular septal defect (VSD) (18 mm), a small atrial septal defect (ASD), and a double-chambered right ventricle with a 90 mm Hg gradient. She had been monitored by several pediatric cardiologists since the age of 1 year, and she had no abnormalities except for her cardiac disease. These features were also confirmed with cardiac magnetic resonance imaging (MRI). After that examination, the patient was referred to our clinic for surgical correction. She had no symptoms and her oxygen saturation was 92% to 93% in the operating room before anesthesia.

The operation was begun with a median sternotomy. After the pericardium was opened, the external finding of the heart was not consistent with the preoperative echocardiographic and MRI findings. The heart was not as big as expected, and it had a bifid apex with a 2-cm deep cleft like a crab fork (Figure 1). The pulmonary arteries were of normal size. Right atriotomy revealed a big ASD (2 cm). The right ventricular volume was less than normal and the tricuspid valve was small in diameter. No VSD could be seen through right atriotomy. Normal saline was also flushed through left ventricle but nothing exited via the right ventricle. The pulmonary arteries were controlled and the right ventricular outflow tract was free of obstructive lesions. Because the right ventricular volume was less than normal, the ASD was closed partially.


Figure 1
View larger version (124K):
[in this window]
[in a new window]
  		Figure 1. Bifid apex.

 
The patient was weaned from cardiopulmonary bypass without any problem. The postoperative course was uneventful, and the patient was discharged on the seventh postoperative day with an oxygen saturation of 96% to 97%.

When we compared the cardiac MRI after the operation with the intraoperative morphology, we saw that there was a large VSD but that it had no connection with the right ventricle. Another chamber was present between the right and the left ventricles, and the VSD connected only with the left one. A septumlike structure separated this chamber and right ventricle. Also, the heart had a bifid apex as seen in the cardiac MRI (Figure 2).


Figure 2
View larger version (103K):
[in this window]
[in a new window]
  		Figure 2. Cardiac MRI of the patient. ra, Right atrium, lv, left ventricle; la, left atrium; white arrow, VSD; black arrow, ASD; *third chamber.

 
The right and left ventricles develop as independent chambers on either side of the primitive plate. Subsequently, they merge and muscle fibers form a bridge across the two ventricles. 1 Go As in our case, the separation of the two ventricles is not complete. Although the bifid cardiac apex is seen in sea mammals, such as the whale, dugong, and manatee, it is a unique congenital morphology for human beings. 1 Go It is seen rarely in the normal human heart or association with other congenital cardiac anomalies.

With these findings, we believe that this kind of morphology (bifid apex with a small right ventricle, third chamber–like development, and ASD) may be seen rarely and has not been documented before in the literature.

References

  1. Victor S, Nayak VM. Bifid apex, persistent left superior vena cava, muscularised coronary sinus, bare atrioventricular cleft, bilateral hepatocardiac channels and bull's horn right atrial appendage. congenital defects possibly due to phylogenic downgrading of genes. Indian J Thorac Cardiovasc Surg. 2003;19:178-183.



This article has been cited by other articles:


Home page
 J. Thorac. Cardiovasc. Surg.Home page
M. Basaran
Bifid cardiac apex: A rare morphologic structure.
J. Thorac. Cardiovasc. Surg., November 1, 2006; 132(5): 1245 - 1245.
[Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
O. A. Sayin, M. Ugurlucan, and E. Tireli
Reply to the editor.
J. Thorac. Cardiovasc. Surg., November 1, 2006; 132(5): 1245 - 1245.
[Full Text] [PDF]

This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Emin Tireli
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Sayin, O. A.
Right arrow Articles by Tireli, E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Sayin, O. A.
Right arrow Articles by Tireli, E.
Related Collections
Right arrow Cardiac - other
Right arrow Congenital - acyanotic

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS