Figure Legends
Figure 1. The echocardiographic image in the apical 4 chamber view shows
both atrial appendages to be morphological left (red asterisks). Note
the dilated coronary sinus (CS). The inset shows the subcostal axial
view, revealing a venous channel (yellow asterisk) coursing posterior to
the descending thoracic aorta (red asterisk). This is the interrupted
inferior caval vein. The atrioventricular connections are mixed with
right-handed ventricular topology (RV and LV). The modified high
parasternal view in panel B shows the continuation of the inferior caval
vein through the azygos vein to the left superior caval vein.
Abbreviations : LA, left atrium; LSCV, left superior caval vein; LV,
left ventricle; RA, right atrium; RV, right ventricle]
Figure 2: Volume rendered images (A, anterior view, and B, left anterior
oblique view) in a patient with right isomerism showing both appendages
to be morphologically right (*right sided morphologically right
appendage, **left sided morphologically right appendage). Panel C,
showing a posterior view, and panel D, a right lateral view, show the
all four pulmonary veins draining at the junction of superior caval vein
(SCV) with right atrium (RA) (black arrow in D).]
Figure 3: Axial computed tomographic images in a patient with right
isomerism show, in panel A, a transverse midline liver. Panel B shows
bilateral right bronchial morphology. The coronal image in panel C shows
bilateral superior caval veins, each draining to its own atrium (R:
right-sided morphologically right atrium; L: left-sided morphologically
left atrium). The volume rendered images in panels D and E show the
right-sided (*) and left-sided appendages (**), both morphologically
right. As seen in panel F, all pulmonary veins (arrowheads) drain to the
right-sided atrium
Figure 4: The volume rendered images, shown in panel A in right anterior
oblique view, in panel B in left anterior oblique view, and in panel C
in posterior view, show bilateral appendages of right morphology, with
all pulmonary veins joining the right-sided atrium. Abbreviations: RA:
right-sided atrium; LA: left-sided atrium; RV: right ventricle; LV: left
ventricle; RSPV: right superior pulmonary vein; RIPV: right inferior
pulmonary vein; LSPV: left superior pulmonary vein; LIPV: left inferior
pulmonary vein, *right sided morphologically right atrial appendage,
**left sided morphologically right atrial appendage]
Figure 5: Panels A and B show axial images, and Panels C and D show
volume rendered images from a patient with right isomerism and pulmonary
atresia. All the pulmonary veins (indicated by arrowheads) are connected
to the right-sided atrium with a morphologically right appendage (RA).
Note the co-existing defect in the oval fossa (white asterisk in B) and
the perimembranous ventricular septal defect (black asterisk in B and
C). Oblique axial image, as seen in panel E, shows pulmonary atresia
(black arrow) with good-sized confluent pulmonary arteries. Oblique
coronal image, seen in panel F, shows a patent arterial duct (indicated
by star) feeding the pulmonary arteries. Abbreviations : RAA: right
atrial appendage; LA: left-sided atrium; RV: right ventricle; LV: left
ventricle; LPA: left pulmonary artery; RPA: right pulmonary artery.]
Figure 6: Panel A shows a coronal image, and panel B a volume rendered
image, from a patient with left isomerism. There is azygos continuation
of the inferior caval vein, with the azygous vein (*) draining into the
superior caval vein (SCV). Panels C through E show volume-rendered
images subsequent to repair using the Kawashima procedure, with the
superior caval vein connected to the pulmonary arteries. Abbreviations :
RPA: right pulmonary artery; LPA: left pulmonary artery.
Figure 7: Panel A is an axial image from a patient with left isomerism,
showing multipler spleens (yellow circle). The coronal minimal intensity
projection image in panel B shows left bronchial isomerism. The volume
rendered images seen in panel C, an anterior view, shows the hepatic
veins (arrowed) draining into the right-sided atrium, which has a
morphologically left appendage. Panel D, a sagittal image, demonstrates
azygos (*) continuation of the inferior caval vein into the superior
caval vein (SCV).
Figure 8: The volume rendered image (Panel A) from a patient with left
isomerism shows hemiazygos (black arrows) continuation of the inferior
caval vein into the left-sided superior caval vein (LSCV), which has
been anastomosed to the pulmonary artery. Panel B shows separate hepatic
veins (arrowheads) rerouted to the right pulmonary artery (RPA) via a
graft (*). The maximum intensity projection image in panel C shows a
pulmonary arteriovenous malformation (thick white arrow) in the left
lower lobe.
Figure 9: The volume rendered image (Panel A) and the oblique coronal
images (Panels B and C) are from a patient with left isomerism in whom
the left-sided superior caval vein (LSCV) has been anastomosed to the
left pulmonary artery (RPA). The hepatic veins (arrowheads) and the
inferior caval vein have been connected to the right pulmonary artery
(RPA) via a conduit whiuch is partly extracardiac and partly
interatrial.
Figure 10: The volume rendered images, shown in a posterior view (panel
A), a left anterior oblique view (panel B), and an anterior view (panel
C), are from a postoperative patients with left isomerism who developed
pulmonary arteriovenous malformations. There is hemizaygos (*)
continuation of the inferior vena cava into the superior caval vein
(SCV), which in turn has been anastomosed to the pulmonary arteries. The
maximum intensity projection image in panel D shows a pulmonary
arteriovenous malformation (yellow arrow) in the left lower lobe.
Abbreviations : RPA: right pulmonary artery; LPA: left pulmonary artery.