Supero-Inferior Ventricles, Criss-Cross Atrioventricular Connections and the Straddling Atrioventricular Valve

  • R. M. Freedom


Supero-inferior ventricles, criss-cross atrioventricular connections, and straddling of either or both atrioventricular valves are not clinical or “stethoscope” bedside diagnoses. Rather these are diagnoses usually established by contemporary imaging modalities including cross-sectional echocardiography, angiocardiography, and there is now some experience with magnetic resonance imaging. Yet the implication of these diagnoses in the neonate with congenital heart disease may be far reaching, and for this reason these reasonably uncommon lesions are considered here.


Mitral Valve Right Ventricle Ventricular Septal Defect Interventricular Septum Right Atrium 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Anderson KR, Lie JT, Sieg K, Hagler DJ, Ritter DG, Davis GD (1977) A criss-cross heart: detailed anatomic description and discussion of morphogenesis. Mayo Clin Proc 52: 569–575PubMedGoogle Scholar
  2. 2.
    Anderson RH (1982) A question of definition. Criss-cross hearts revisited. Pediatr Cardiol 3: 305–313PubMedCrossRefGoogle Scholar
  3. 3.
    Anderson RH (1985) Straddling and overriding valves. Int J Cardiol 9: 323–326CrossRefGoogle Scholar
  4. 4.
    Anderson RH, Shinebourne EA, Gerlis LM (1974) Crisscross atrioventricular relationships producing paradoxical atrioventricular concordance or discordance. Their significance to nomenclature of congenital heart disease. Circulation 50: 176–180Google Scholar
  5. 5.
    Anderson RH, Macartney FJ, Shinebourne EA, Tynan M (1987) Paediatric Cardiology, vol. 2. Churchill Livingstone, Edinburgh, pp 697–709Google Scholar
  6. 6.
    Anderson RH, Smith A, Wilkinson JL (1987) Disharmony between atrioventricular connections and segmental combinations: unusual variants of “crisscross” hearts. J Am Coll Cardiol 10: 1274–1277PubMedCrossRefGoogle Scholar
  7. 7.
    Ando M, Takao A, Nihmura I, Mori K (1976) Crossing atrioventricular valves, clinical study of 8 cases. Circulation 53 and 54 (Suppl II): 90Google Scholar
  8. 8.
    Attie F, Munoz-Castellanos L, Ovseyevitz J et al. (1980) Crossed atrioventricular connections. Am Heart J 99: 163–172PubMedCrossRefGoogle Scholar
  9. 9.
    Aziz KU, Paul MH, Muster AJ, Idriss FS (1979) Positional abnormalities of atrioventricular valves in transposition of the great arteries including double-outlet right ventricle, atrioventricular valve straddling and malattachment. Am J Cardiol 44: 1135–1145PubMedCrossRefGoogle Scholar
  10. 10.
    Barron JV, Sahn DJ, Valdes-Cruz LM et al. (1984) Two-dimensional echocardiographic evaluation of overriding and straddling atrioventricular valves associated with complex congenital heart disease. Am Heart J 107: 1006–1014PubMedCrossRefGoogle Scholar
  11. 11.
    Becker AE, Ho SY, Caruso G, Milo S, Anderson RH (1980) Straddling right atrioventricular valves in atrioventricular discordance. Circulation 61: 1133–1141PubMedGoogle Scholar
  12. 12.
    Bharati S, McAllister Jr HA, Lev M (1979) Straddling and displaced atrioventricular orifices and valves. Circulation 60: 673–684PubMedGoogle Scholar
  13. 13.
    Bini RM, Pellegrino PA, Mazzucco A et al. (1980) Tricuspid atresia with double-outlet left atrium. Chest 78: 109–111PubMedCrossRefGoogle Scholar
  14. 14.
    Carminati M, Valsecchi O, Borghi A et al. (1987) Cross-sectional echocardiographic study of criss-cross hearts and superoinferior ventricles. Am J Cardiol. 59: 114–118PubMedCrossRefGoogle Scholar
  15. 15.
    Coto EO, Jimenez MQ, Cabrera A, Deverall PB, Caffarena JM (1978) Aortic levopositions without ventricular inversion. Eur J Cardiol 8: 523–541PubMedGoogle Scholar
  16. 16.
    Coto EO, Wilkinson JL, Rufilanchas JJ, Marquez J (1979) Gross distortion of atrioventricular and ventriculoarterial relations associated with left juxtaposition of atrial appendages. Bizarre form of atrioventricular crisscross. Br Heart J 41: 486–492Google Scholar
  17. 17.
    Coto EO, Calabro R, Marsico F, Arranz JSL (1981) Right atrial outlet atresia with straddling left atrioventricular valve: a form of double outlet atrium. Br Heart J 45: 317–324PubMedCrossRefGoogle Scholar
  18. 18.
    Danielson GK, Tabry IF, Fulton RE, Hagler DJ, RitterDG (1979) Successful repair of straddling atrioventricular valve by technique used for septation of univentricular heart. Ann Thorac Surg 28: 554–560PubMedCrossRefGoogle Scholar
  19. 19.
    Danielson GK, Tabry IF, Ritter DG, Fulton RE (1979) Surgical repair of criss-cross heart with straddling atrioventricular valve. J Thorac Cardiovasc Surg 77: 847–851PubMedGoogle Scholar
  20. 20.
    de Vivie R, Van Praagh S, Bein G, Eigster G, Vogt J, Van Praagh R (1989) Transposition of the great arteries with straddling tricuspid valve. Report of 2 cases with acquired subaortic stenosis after main pulmonary artery banding. J Thorac Cardiovasc Surg 98: 205–213PubMedGoogle Scholar
  21. 21.
    Dunn JM, Donner R, Black I, Balsara RK (1982) Palliative repair of transposition of the great arteries with crisscross heart: ventricular septal defect and hypoplastic right (systemic) ventricle. J Thorac Cardiovasc Surg 83: 755–760PubMedGoogle Scholar
  22. 22.
    Erath HGJ, Graham Jr TP, Hammon Jr JW, Smith CW (1980) Hypoplasia of the systemic ventricle in congeni-tally corrected transposition of the great arteries. Preoperative documentation and possible implications of operation. J Thorac Cardiovasc Surg 79: 770–775Google Scholar
  23. 23.
    Fontes VF, Sousa JEMR, Lima MR, Medeiros JH, Souza LCB (1978) Relacoes atrioventriculares entrecruzadas ‘criss-cross heart’ -apresentacao de 3 casos. Arq Bras Cardiol 3: 71–77Google Scholar
  24. 24.
    Franco-Vazquez JS, Perez-Trevino C, Gaxiola A (1973) Corrected transposition of the great arteries with extreme counter-clockwise torsion of the heart. Acta Cardiol 28: 636–643PubMedGoogle Scholar
  25. 25.
    Freedom RM (1983) Supero-inferior ventricle and criss-cross atrioventricular connections: an analysis of the myth and mystery. In: Belloli GP, Squarcia V (eds) Pediatric cardiology and cardiosurgery. Modern problems in paediatrics. Karger, Basel, pp 48–62Google Scholar
  26. 26.
    Freedom RM, Harrington DP, White Jr RI (1974) The differential diagnosis of levo-transposed or malposed aorta. An angiocardiography study. Circulation 50: 1040–1046Google Scholar
  27. 27.
    Freedom RM, Bini R, Dische R, Rowe RD (1978) The straddling mitral valve: morphological observations and clinical implications. Eur J Cardiol 8: 27–50PubMedGoogle Scholar
  28. 28.
    Freedom RM, Culham G, Rowe RD (1978) The criss-cross and superoinferior ventricular heart: an angiocardiographic study. Am J Cardiol 42: 620–628PubMedCrossRefGoogle Scholar
  29. 29.
    Freedom RM, Culham JAG, Moes CAF (1984) Angiocardiography of congenital heart disease. Macmillan, New York, pp 629–642Google Scholar
  30. 30.
    Galinanes M, Chartrand C, Van Doesburg NH, Guerin R, Stanley P (1985) Surgical repair of superoinferior ventricles: experience with three patients. Ann Thorac Surg 40: 353–359PubMedCrossRefGoogle Scholar
  31. 31.
    Gussenhoven EJ, Essed CE, Bos E, de Villeneuve VH (1984) Echocardiographic diagnosis of overriding tricuspid valve in a child with Ebstein’s anomaly. Pediatr Cardiol 5: 209–212PubMedCrossRefGoogle Scholar
  32. 32.
    Gutgesell HP, Cheatham J, Latson LA, Nihill MR, Mullins CE (1983) Atrioventricular valve abnormalities in infancy: two-dimensional echocardiographic and angiocardiographic comparison. J Am Coll Cardiol 2: 531–537PubMedCrossRefGoogle Scholar
  33. 33.
    Guthaner D, Higgins CB, Silverman JF, Hayden WG, Wexler L (1976) An unusual form of the transposition complex. Uncorrected levo-transposition with horizontal ventricular septum: report of 2 cases. Circulation 53: 190–195PubMedGoogle Scholar
  34. 34.
    Hery E, Jimenez M, Didier D et al. (1989) Echocardiog-raphic and angiographic findings in superior-inferiorcardiac ventricles. Am J Cardiol 63: 1385–1389PubMedCrossRefGoogle Scholar
  35. 35.
    Ho SY, Milo S, Anderson RH et al. (1982) Straddling atrioventricular valve with absent atrioventricular con-nection: report of 10 cases. Br Heart J 47: 344–352PubMedCrossRefGoogle Scholar
  36. 36.
    Huhta JC, Edwards WD, Danielson GK, Feldt RH (1982) Abnormalities of the tricuspid valve in complete transposition of the great arteries with ventricular septal defect. J Thorac Cardiovasc Surg. 83: 569–576PubMedGoogle Scholar
  37. 37.
    Isomatsu Y, Kurosawa H, Imai Y (1989) Straddling tricuspid valve without a ventricular septal defect. Br Heart J 62: 222–224PubMedCrossRefGoogle Scholar
  38. 38.
    Kinsley RH, McGoon DC, Danielson GK (1974) Corrected transposition of the great arteries. Associated ventricular rotation. Circulation 49: 574–578Google Scholar
  39. 39.
    Kitamura N, Takao A, Ando M, Imai Y, Konno S (1974) Taussig-Bing heart with mitral valve straddling. Case reports and portmortem study. Circulation. 49: 761–767Google Scholar
  40. 40.
    Lev M, Rowlatt UF (1961) The pathologic anatomy of mixed levocardia. A review of 13 cases of atrial or ventricular inversion with or without corrected trans-position. Am J Cardiol 8: 216–263PubMedCrossRefGoogle Scholar
  41. 41.
    Liberthson RR, Paul MH, Muster AJ, Arcilla RA, Eckner FAO, Lev M (1971) Straddling and displaced atrioventricular orifices and valves with primitive ventricles. Circulation. 43: 213–226PubMedGoogle Scholar
  42. 42.
    Marino B, Chiariello L, Bosman C et al. (1982) Criss-cross heart with discordant atrioventricular connections. Pediatr Cardiol 3: 315–318PubMedCrossRefGoogle Scholar
  43. 43.
    Marino B, Sanders SP, Pasquini L, Giannico S, Parness IA, Colan SD (1986) Two-dimensional echocardiographic anatomy in criss-cross heart. Am J Cardiol 58: 325–333PubMedCrossRefGoogle Scholar
  44. 44.
    Milo S, Ho SY, Macartney FJ et al. (1979) Straddling and overriding atrioventricular valves: morphology and classification. Am J Cardiol 44: 1122–1134PubMedCrossRefGoogle Scholar
  45. 45.
    Muster AJ, Bharati S, Aziz KU et al. (1979) Taussig-Bing anomaly with straddling mitral valve. J Thorac Cardiovasc Surg 77: 832–842PubMedGoogle Scholar
  46. 46.
    Nakada I, Nakamura T, Matsumoto H, Sezaki T (1983) Successful repair of criss-cross heart using modified Fontan operation. Chest 3: 569–570CrossRefGoogle Scholar
  47. 47.
    Pacifico AD, Soto B, Bargeron LM Jr (1979) Surgical treatment of straddling tricuspid valves. Circulation 60: 655–664PubMedGoogle Scholar
  48. 48.
    Restivo A, Ho SY, Anderson RH, Cameron H, Wilkinson JL (1982) Absent left atrioventricular connection with right atrium connected to morphologically left ventricular chamber, rudimentary right ventricular chamber, and ventriculoarterial discordance. Problem of mitral versus tricuspid atresia. Br Heart J 48: 240–248Google Scholar
  49. 49.
    Rice MJ, Seward JB, Edwards WD et al. (1985) Strad-dling atrioventricular valve: two-dimensional echocardiographic diagnosis, classification and surgical im-plications. Am J Cardiol 55: 505–513PubMedCrossRefGoogle Scholar
  50. 50.
    Robinson PJ, Kumpeng V, Macartney FJ (1985) Cross-sectional echocardiographic and angiographic correlation in criss-cross hearts, Br Heart J 54: 61–67PubMedCrossRefGoogle Scholar
  51. 51.
    Santos MA, Simoes LC (1987) Paroxysmal supra-ventricular tachycardia in supero-inferior ventricles with intact ventricular septum. Int J Cardiol 14: 232–235PubMedCrossRefGoogle Scholar
  52. 52.
    Sato K, Ohara S, Tsukaguchi I et al. (1978) a criss-cross heart with concordant atrioventriculo-arterial connections. Report of a case. Circulation 57: 396–400Google Scholar
  53. 53.
    Schneeweiss A, Shem-Tov A, Neufeld HN (1981) Coronary arterial pattern in supero-inferior ventricular heart. Implications on significance of morphogenesis of this anomaly. Br Heart J 46: 559–561Google Scholar
  54. 54.
    Schneeweiss A, Shem-Tov A, Blieden LC, Deutsch V, Neufeld HN (1982) Criss-cross heart -a case with horizontal septum, complete transposition, pulmonary atresia and ventricular septal defect. Pediatr Cardiol 3: 325–328PubMedCrossRefGoogle Scholar
  55. 55.
    Sennari E, Sato Y, Matsuoka Y, Okishima T, Hayakawa K, Ando M (1985) Unique types of criss-cross heart. Jpn Circ J 49: 329–334PubMedCrossRefGoogle Scholar
  56. 56.
    Seward JB, Tajik AJ, Ritter DG (1975) Echocardiographic features of straddling tricuspid valve. Mayo Clin Proc 50: 427–434PubMedGoogle Scholar
  57. 57.
    Sieg K, Hagler DJ, Ritter DG et al. (1977) Straddling right atrioventricular valve in criss-cross atrioventricular relationship. Mayo Clin Proc 52: 561–568PubMedGoogle Scholar
  58. 58.
    Smallhorn JF, Tommasini G, Macartney FJ (1981) Detection and assessment of straddling and overriding atrioventricular valves by two-dimensional echocardiography. Br Heart J 46: 254–262PubMedCrossRefGoogle Scholar
  59. 59.
    Snider AR, Enderlein MA, Teitel DF, Hirji M, Heymann MA (1984) Isolated ventricular inversion: two-dimensional echocardiographic findings and a review of the literature. Pediatr Cardiol 5: 27–33PubMedCrossRefGoogle Scholar
  60. 60.
    Soto B, Ceballos R, Nath PH, Bini RM, Pacifico AD, Bargeron LM Jr (1985) Overriding atrioventricular valves. An angiographic-anatomical correlate. Int J Cardiol 9: 327–339Google Scholar
  61. 61.
    Symons JC, Shinebourne EA, Joseph MC, Lincoln C, Ho SY, Anderson RH (1977) Criss-cross heart with congenitally corrected transposition: report of a case with d-transposed aorta and ventricular pre-excitation. Eur J Cardiol 5: 493–505PubMedGoogle Scholar
  62. 62.
    Tabry IF, McGoon DC, Danielson GK, Wallace RB, Tajik AJ, Seward JB (1979) Surgical management of straddling atrioventricular valve. J Thorac Cardiovasc Surg 77: 191–201PubMedGoogle Scholar
  63. 63.
    Tandon R, Moller JH, Edwards JE (1973) Communication of mitral valve with both ventricles associated with double-outlet right ventricle. Circulation 48: 904–908PubMedGoogle Scholar
  64. 64.
    Van Mill G, Moulaert A, Harinck E, Wenink A, Oppenheimer-Dekker A (1982) Subcostal two-dimensional echocardiographic recognition of a criss-crossGoogle Scholar
  65. 65.
    heart with discordant ventriculo-arterial connection. Pediatr Cardiol 3:319–323Google Scholar
  66. 66.
    Van Praagh R (1987) When concordant or discordant atrioventricular alignments predict the ventricular situs wrongly. I. Solitus atria, concordant alignments, and L-loop ventricles. II. Solitus atria, discordant alignments, and D-loop ventricles. J Am Coll Cardiol 10: 1278–1279PubMedCrossRefGoogle Scholar
  67. 67.
    Van Praagh S, La Corte M, Fellows KE et al. (1980) Supero-inferior ventricles: anatomic and angiocardiographic findings in 10 postmortem cases. In: Van Praagh R, Takao A (eds) Etiology and morphogenesis of congenital heart disease. Futura, Mount Kisco, New York, pp 317–378Google Scholar
  68. 68.
    Van Praagh R, Weinberg PM, Smith SD, Foran RB, Van Praagh S (1989) Malpositions of the heart. In: Adams FH, Emmanouilides GC, Riemenschneider TA (eds) Moss’ heart disease in infants, children and adolescents. Williams and Wilkins, Baltimore, pp 530–580Google Scholar
  69. 69.
    Wagner HR, Alday LE, Vlad P (1970) Juxtaposition of the atrial appendages. A report of 6 necropsied cases. Circulation 42: 157–163PubMedGoogle Scholar
  70. 70.
    Waldhausen JA, Pierce WS, Whitman V (1977) Horizontal interventricular septum in congenital heart disease: surgical considerations. Ann Thorac Surg 23: 271–275PubMedCrossRefGoogle Scholar
  71. 71.
    Weinberg PM, Van Praagh R, Wagner HR, Cuaso CC (1980) New form of criss-cross atrioventricular relation: an expanded view of the meaning of D-and L-loops. World Congress of Paediatric Cardiology, London (abstract 319 ).Google Scholar
  72. 72.
    Wenink ACG, Gittenberger-de Groot AC (1982) Straddling mitral and tricuspid valves: morphologic differences and developmental backgrounds. Am J Cardiol 49: 1959–1977PubMedCrossRefGoogle Scholar
  73. 73.
    Zach M, Beitzke A, Gypser G, Hofler H (1978) Die transposition der groben Gefabe mit horizontalem interventrikularen Septum. Herz 3: 133–137PubMedGoogle Scholar
  74. 74.
    Zach M, Singer H, Loser H, Hagel KJ (1980) The horizontal interventricular septum. Three cases with different ventriculoarterial connections. Eur J Cardiol 11: 269–282Google Scholar

Copyright information

© Springer-Verlag London Limited 1992

Authors and Affiliations

  • R. M. Freedom

There are no affiliations available

Personalised recommendations