Subcostal two-dimensional echocardiographic recognition of a criss-cross heart with discordant ventriculo-arterial connection

Two-dimensional echocardiography was performed on a patient with criss-cross atrioventricular (AV) relationship and ventriculo-arterial discordance. A systematic approach from the subcostal area revealed the complex cardiac pathology including the criss-cross AV relationship of right and left heart, indicating that this very abnormal relationship can be identified echocardiographically. The echocardiographic findings were confirmed by angiocardiography. Post-mortem investigation showed that much of the complexity, including the criss-cross AV relationship, had been caused by a secondary leftward torsion of the entire ventricular part of the heart.