Outcomes of left atrial isomerism over a 28-year period at a single institution
Thomas Gilljam, MD, PhD*  ,
Brian W. McCrindle, MD, MPH, FACC* ,
Jeffrey F. Smallhorn, MBBS, FACC* ,
William G. Williams, MD, FRCS(C)* and
Robert M. Freedom, MD, FACC*
* Division of Cardiology, the Department of Pediatrics, the Hospital For Sick Children and the University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
Division of Cardiovascular Surgery, the Department of Surgery, the Hospital For Sick Children and the University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
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Figure 1 Flow chart depicting course for patients with a normal heart, a heart suitable for biventricular repair and a heart suitable for single-ventricle surgery. For results of surgery, see Figure 2.
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Figure 2 Flow chart of interventions in 163 patients with left atrial isomerism. *Comprising 9 patients with biventricular hearts, 23 with single ventricle and 22 with normal hearts; **four patients had Fontan-type surgery without prior interventions. Fontan-type includes bidirectional cavopulmonary shunt, right-atrium-to-pulmonary-artery anastomosis and hepatic-vein-to-pulmonary-artery rerouting.
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Figure 3 Kaplan-Meier survival (central line) with 95% confidence limits (outer lines) in 163 patients with left atrial isomerism.
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Figure 4 Kaplan-Meier survival in 163 patients with left atrial isomerism and a normal heart (n = 22), a heart suitable for biventricular repair (n = 71) and a heart suitable for single-ventricle surgery (n = 70). Survivors are denoted by dots. Vertical bars represent 95% confidence limits. Differences between groups were analyzed using the log-rank and Wilcoxon tests.
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