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J Thorac Cardiovasc Surg 2006;132:1245
© 2006 The American Association for Thoracic Surgery

Letter to the Editor

Bifid cardiac apex: A rare morphologic structure

Goztepe Safak Hospital, Kadikoy Istanbul, Turkey

To the Editor:

I read with great interest the case reported by Sayin and associates¹ in the February 2006 issue of the Journal. In this article, the authors presented an exceedingly uncommon pathologic condition and provided new insights about the extremes of cardiac morphogenesis. Although the described case is interesting, there are some concerns about the surgical technique. I would like to make the following comments.

The authors reported that the preoperative oxygen saturation was 92% and, by surgical intervention, the arterial oxygen saturation reached 96% postoperatively. As mentioned by the authors, the right ventricular volume was less than normal and the arterial desaturation was probably related to hypoplasia of the right ventricle.

First, the preoperative and postoperative hemodynamic data were lacking, and the reader could not obtain the necessary information from the article about the degree of right ventricular and tricuspid valve hypoplasia. Additionally, the long-term effects of this accessory chamber on right ventricular contractile function are not known. An explanation for why a one and a half ventricle repair was not tried was not convincingly given. Finally, the authors must comment on the possible consequences of partial closure of an atrial septal defect on an already elevated right ventricular pressure.

Another issue with the technique is the persistence of a diverticulum-like chamber communicating with the left ventricle. The magnetic resonance imaging indicates that this chamber is large enough. I wonder why the authors did not consider this blind sac as a potential source of postoperative embolism and arrhythmias.

Because there are scanty data in the literature, such rare anomalies and their surgical corrections should be considered as important opportunities for determining the most accurate surgical approach. The description of a rare congenital anomaly is one aspect of this article, but the applied technique may lead to some interpretive errors because of the lack of necessary data.

References

1. Sayin OA, Ugurlucan M, Dursun M, Ucar A, Tireli E. Bifid cardiac apex: a rare morphologic structure. J Thorac Cardiovasc Surg 2006;131:474-475.[Free Full Text]
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Murat Basaran Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Basaran, M. Search for Related Content PubMed PubMed Citation Articles by Basaran, M. Related Collections Related Article