Juxtaposition of the atrial appendages: a sign of severe cyanotic congenital heart disease.

Juxtaposition of the atrial appendages is an apparently rare congenital cardiac anomaly in which the atrial appendages lie side by side, both to the left or to the right of the great arteries, known as left or right juxtaposition of the atrial appendages, respectively (Dixon, 1954).This abnormality now may readily be diagnosed by angiocardiography (Ellis and Jameson, 1963), and it is widely regarded as an ominous sign of severe cyanotic congenital heart disease.Beyond this general impression, however, the specific types of cardiac malformation likely to be associated with juxtaposition of the atrial appendages, and the rela- tive frequencies of each, remain far from clear.This is not surprising since only 21 post-mortem cases have been published, to our knowledge, almost all as isolated case reports (see Table III).This paper represents an attempt to clarify the picture. MATERIAL, METHODS, AND TERMINOLOGYThis study is based upon 21 necropsied cases of juxtaposition of the atrial appendages from two centres: the Congenital Heart Disease Research and Training Center, Chicago, Illinois, U.S.A., 15 cases; and the Hospital for Sick Children, Toronto, Ontario, Canada, six cases.The heart specimens were measured by the method of Lev, Rowlatt, and Rimoldi (1961) in order to permit quantitative statements concerning chamber mass and volume, and they were measured geometrically by the method of Van Praagh, Ongley, and Swan (1964a) in order to assess relationships accurately.When these methods could not be employed, this is indicated (Tables I and VI).