Crisscross Hearts in Adults: Echocardiographic Evaluation and Natural History

Crisscross heart is a rare congenital, rotational abnormality of the ventricular mass, resulting in the crossing of the inflows of the 2 ventricles and each atrium emptying into the contralaterally located ventricle. Few cases of adult patients are described in the literature. We present a case series of 7 adult patients aged 18 to 53 years with crisscross hearts, followed up for 5 to 22 years (mean 14.4 years) at the Institute of Cardiology Warsaw. Only in 2 patients was the diagnosis of crisscross heart made at infancy. In the remaining 5 patients, the diagnosis was made at the age of 7 to 26 years. All patients had complex congenital heart defects, including double outlet right ventricle in 4 patients and discordant ventriculoarterial connections in 3 patients, with numerous associated lesions. In all patients, the diagnosis of crisscross heart was made by transthoracic echocardiographic examination. Five patients underwent surgical procedures, including Rastelli operation, arterial switch, Glenn anastomosis, and central shunt, according to the individual morphology and hemodynamics. The clinical outcome depended predominantly on the underlying hemodynamic abnormalities and the results of surgical management rather than on crisscross anatomy. Successful surgery allowed acceptable functional status in adulthood.