Visceroatrial situs in congenital heart disease

The visceroatrial situs describes the laterality and relative position of viscera, including the cardiac atria, the tracheobronchial tree, and the abdominal viscera (Spindola-Franco H (1985) Abnormalities of the visceroatrial situs. In: Spindola-Franco H (ed) Radiology of the heart: cardiac imaging in infants, children and adults. Springer, New York/Berlin/Tokyo, pp 620-37). Visceroatrial situs abnormalities are associated with congenital heart disease (Tonkin and Tonkin, AJR Am J Roentgenol 138:509-515, 1982). Mild forms of situs abnormalities may remain undiagnosed and can be incidentally discovered in adults on imaging, while other situs abnormalities are associated with severe congenital anomalies, which are fatal early in life unless treated. Determination of the visceroatrial situs and bulboventricular loop predicts the probability and type of congenital heart disease (Hernanz-Schulman et al., AJR Am J Roentgenol 154:797-802, 1990). This chapter reviews the various configurations of visceroatrial situs and the segmental approach to cardiac anatomy described by van Praagh (Semin Roentgenol 20(3):254-271, 1985). We present a methodical stepwise approach for determining the visceroatrial situs, the bulboventricular loop, and their associated anomalies (Ghosh et al., AJR Am J Roentgenol 193(4):1107-1117, 2009). With the advancement in the diagnosis and treatment of congenital heart disease, patients with situs abnormalities associated with severe congenital heart disease can survive into adulthood. Imaging is essential in diagnosing complications of their long-standing disease or its treatment. We will review the role of CT and MRI in imaging adult congenital heart disease and its relationship to anomalies of visceroatrial situs.