Describing cardiac relations and
connections
Segmental approach to describe cardiac
relations
Developed by Stella and Richard Van Praagh.
Based on the relations of the three major
cardiac segments: atrial chambers, ventricles,
and arterial trunks.
Three letters coded in braces “{}” to describe
the segments:
1. Sidedness of atrial chambers = atrial “situs”
2. Ventricular topology = ventricular “loop”
3. Relationships of the arterial trunks in space
Choices for the first letter:
■ “S” = “situs solitus” = normal arrangement
■ “I” = “situs inversus” = mirror-imaged
arrangement
■ “A” = “situs ambiguus”
■ “X” = unknown
Choices for the second letter:
■ “D” = D-loop
■ “L” = L-loop
■ “X” = looping cannot be determined
Choices for the third letter:
■ “S” = NRGA
■ “I” = inverted/mirror-imaged NRGA
■ “D” = D-transposed/D-malposed great
arteries = aorta to the right of the MPA
■ “L” = L-transposed/L-malposed great
arteries = aorta to the left of the MPA
■ ‘‘A’’ = aorta directly anterior to the
pulmonary trunk
Normal heart = “{S,D,S}”
3
Sequential segmental approach to
describe cardiac connections
Developed by Robert H. Anderson.
Based on the anatomy of the cardiac
components and the junctions (i.e.,
connections) between them.
Description of atrial chambers based on the
morphology of their appendages:
■ Usual/normally arranged
■ Mirror-imaged
■ Isomerism of the morphologically left atrial
appendages
■ Isomerism of the morphologically right
atrial appendages
Description of the AV junctions based on how
the atrial and ventricular chambers are joined
together:
■ Concordant AV connections
■ Discordant AV connections
■ Biventricular and mixed AV connections
■ Double inlet AV connections
■ Absent left AV connections
■ Absent right AV connections
Description of valves guarding the junctions:
■ Two perforate valves
■ One single perforate valve with an absent
AV connection
■ One single perforate with one imperforate
valve
■ Common valve
■ Absentvalvewitha“unguardedorifice”
4
Description of the ventriculo-arterial
junctions based on the way the arterial trunks
origin from the ventricles, the infundibular
morphologies, the morphology of the arterial
valves, and the relationships of the arterial
trunks in space
■ Concordant ventriculoarterial connections
■ Discordant ventriculoarterial connections
■ Concordant ventriculoarterial connections
with parallel great arteries (anatomically
corrected malposition)
■ Single outlet with common arterial trunk
■ Single outlet with PA
■ Single outlet with AA
■ Double outlet
■ DORV
■ Double outlet LV
Normal heart = usual/normally arranged
atrial arrangement with concordant AV
connections and concordant ventriculo-arterial
connections.