Skip to main content
British Heart Journal logoLink to British Heart Journal
. 1975 Aug;37(8):840–852. doi: 10.1136/hrt.37.8.840

Syndromes of asplenia and polysplenia. A review of cardiac and non-cardiac malformations in 60 cases withspecial reference to diagnosis and prognosis.

V Rose, T Izukawa, C A Moës
PMCID: PMC482884  PMID: 1191445

Abstract

This review presents the cardiac and non-cardiac malformations in 60 cases with asplenia and polysplenia with special reference to distinguishing factors which may be helpful in the clinical recognition of these syndromes. The asplenia cases were predominantly male and presented with cyanosis. They frequently had transposition of the great arteries (72%) with pulmonary stenosis or atresia (88%) and total anomalous pulmonary venous drainage (72%). Deaths were caused by cardiac failure and anoxia in 57 per cent of cases. Most of the patients died in the first year of life (79%), but longer survival is possible in the asplenia syndrome. The polysplenia cases were predominantly female and survived longer. The characteristic clinical findings were the relatively more benign presenting signs and the leftward or superiorly orientated P wave axis on the electrocardiogram. Conotruncal abnormalities were less common and total anomalous pulmonary venous drainage did not occur. On angiography the inferior vena caval drainage via the azygos system was clearly identified and this was present in all cases at surgery. Our study indicated that the cardiac anomalies in polysplenia were less severe than they were in asplenia and therefore the prognosis in the former syndrome is likely to be more favourable. Three families had two affects sibs but no single genetic factor could be identified. The aetiology of these syndromes remains undetermined.

Full text

PDF
840

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Chen S., Thompson M. W., Rose V. Endocardial fibroelastosis: family studies with special reference to counseling. J Pediatr. 1971 Sep;79(3):385–392. doi: 10.1016/s0022-3476(71)80145-2. [DOI] [PubMed] [Google Scholar]
  2. DE LA CRUZ M. V., POLANSKY J., NAVARRO-LOPEZ F. The diagnosis of corrected transposition of the great vessels. Br Heart J. 1962 Jul;24:483–497. doi: 10.1136/hrt.24.4.483. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Elliott L. P., Cramer G. G., Amplatz K. The anomalous relationship of the interior vena cava and abdominal aorta as a specific angiocardiographic sign in asplenia. Radiology. 1966 Nov;87(5):859–863. doi: 10.1148/87.5.859. [DOI] [PubMed] [Google Scholar]
  4. Freedom R. M. The asplenia syndrome: a review of significant extracardiac structural abnormalities in 29 necropsied patients. J Pediatr. 1972 Dec;81(6):1130–1133. doi: 10.1016/s0022-3476(72)80244-0. [DOI] [PubMed] [Google Scholar]
  5. Freedom R. M., Treves S. Splenic scintigraphy and radionuclide venography in the heterotaxy syndrome. Radiology. 1973 May;107(2):381–386. doi: 10.1148/107.2.381. [DOI] [PubMed] [Google Scholar]
  6. Kessler H., Smulewicz J. J. Microgastria associated with agenesis of the spleen. Radiology. 1973 May;107(2):393–396. doi: 10.1148/107.2.393. [DOI] [PubMed] [Google Scholar]
  7. Landing B. H., Lawrence T. Y., Payne V. C., Jr, Wells T. R. Bronchial anatomy in syndromes with abnormal visceral situs, abnormal spleen and congenital heart disease. Am J Cardiol. 1971 Oct;28(4):456–462. doi: 10.1016/0002-9149(71)90010-5. [DOI] [PubMed] [Google Scholar]
  8. Moller J. H., Nakib A., Anderson R. C., Edwards J. E. Congenital cardiac disease associated with polysplenia. A developmental complex of bilateral "left-sidedness". Circulation. 1967 Nov;36(5):789–799. doi: 10.1161/01.cir.36.5.789. [DOI] [PubMed] [Google Scholar]
  9. Momma K., Linde L. M. Cardiac rhythms in dextrocardia. Am J Cardiol. 1970 Apr;25(4):420–427. doi: 10.1016/0002-9149(70)90008-1. [DOI] [PubMed] [Google Scholar]
  10. POLHEMUS D. W., SCHAFER W. B. Congenital absence of the spleen. Pediatrics. 1955 Oct;16(4):495–497. [PubMed] [Google Scholar]
  11. POLHEMUS D. W., SCHAFER W. B. Congenital absence of the spleen; syndrome with atrioventricularis and situs inversus; case reports and review of the literature. Pediatrics. 1952 Jun;9(6):696–708. [PubMed] [Google Scholar]
  12. PUTSCHAR W. G., MANION W. C. Congenital absence of the spleen and associated anomalies. Am J Clin Pathol. 1956 May;26(5):429–470. doi: 10.1093/ajcp/26.5.429. [DOI] [PubMed] [Google Scholar]
  13. Padmanabhan J., Risemberg H. M., Rowe R. D. Howell-Jolly bodies in the peripheral blood of full-term and premature neonates. Johns Hopkins Med J. 1973 Mar;132(3):146–150. [PubMed] [Google Scholar]
  14. RUTTENBERG H. D., NEUFELD H. N., LUCAS R. V., Jr, CAREY L. S., ADAMS P., Jr, ANDERSON R. C., EDWARDS J. E. SYNDROME OF CONGENITAL CARDIAC DISEASE WITH ASPLENIA. DISTINCTION FROM OTHER FORMS OF CONGENITAL CYANOTIC CARDIAC DISEASE. Am J Cardiol. 1964 Mar;13:387–406. doi: 10.1016/0002-9149(64)90454-0. [DOI] [PubMed] [Google Scholar]
  15. SCHONFELD E. A., FRISCHMAN B. Syndrome of spleen agenesis, defects of the heart and vessels and situs inversus; report of a case suggesting heredity as an etiological factor. Helv Paediatr Acta. 1958 Dec;13(6):636–640. [PubMed] [Google Scholar]
  16. SHAH K. D., NEILL C. A., WAGNER H. N., Jr, TAUSSIG H. B. RADIOISOTOPE SCANNING OF THE LIVER AND SPLEEN IN DEXTROCARDIA AND IN SITUS INVERSUS WITH LEVOCARDIA. Circulation. 1964 Feb;29:231–241. doi: 10.1161/01.cir.29.2.231. [DOI] [PubMed] [Google Scholar]
  17. Silver W., Steier M., Chandra N. Asplenia syndrome with congenital heart disease and tetralogy of Fallot in siblings. Am J Cardiol. 1972 Jul 11;30(1):91–94. doi: 10.1016/0002-9149(72)90132-4. [DOI] [PubMed] [Google Scholar]
  18. VANPRAAGH R., VANPRAAGH S., VLAD P., KEITH J. D. DIAGNOSIS OF THE ANATOMIC TYPES OF CONGENITAL DEXTROCARDIA. Am J Cardiol. 1965 Feb;15:234–247. doi: 10.1016/0002-9149(65)90460-1. [DOI] [PubMed] [Google Scholar]
  19. Van der Horst R. L., Gotsman M. S. Abnormalities of atrial depolarization in infradiaphragmatic interruption of inferior vena cava. Br Heart J. 1972 Mar;34(3):295–300. doi: 10.1136/hrt.34.3.295. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES