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This letter was referred to Dr. Ahmet Sasmazel, who replies in this manner:
In Figure 2A, multislice computed tomographic examination of the anterior aspect of the heart revealed a right atrial isomerism, which has a blunt, conical shape. Intraoperatively, the right-sided atrial appendix did not have a finger-like appearance: it had a broad junction and a wide base. When we opened the right-sided atrium, we saw the pectinate muscles and the crista terminalis in the right-sided atrial appendix. An abdominal radiograph and a computed tomographic scan, both performed before surgery, revealed abdominal situs inversus with a left-sided liver and polysplenia. As Anderson and colleagues1 describe it, abdominal polysplenia may exist without atrial isomerism, and a splenic state does not always predict the atrial morphology. Therefore, we called this a case of right atrial isomerism. (A better term might be “heterotaxy syndrome,” due to the morphology of the atrial appendages and the presence of polysplenia.) In regard to the position of the ventricles at surgery, the left ventricle was just posterior to the right one.