The role of imaging in the diagnosis and approach of criss-cross heart: a scoping review and case series

Criss-Cross Heart is a congenital cardiac condition characterized by the anomalous twisting of the ventricles relative to the atria during embryonic development. The aim of this study is to assess the advantages and limitations of diagnostic imaging for the diagnosis and approach of patients with Criss-Cross Heart through a scoping review, associated to a case series. A retrospective study was conducted on four patients diagnosed with Criss-Cross Heart. Diagnostic tools including echocardiography, chest radiography, cardiac computed tomography, magnetic resonance imaging, and cardiac catheterization were evaluated. The scoping review was performed using databases such as PubMed, Lilacs, and ScienceDirect, yielding 168 articles, of which 33 were included after screening and analyzing the information within the text. Echocardiography was the most effective diagnostic modality in all the four cases, as well as according to the literature available, accurately identifying the abnormal atrioventricular connections and associated cardiac defects. Cardiac catheterization and angiography provided crucial anatomic details for surgical planning, particularly in visualizing collateral vessels and coronary artery patterns. Cardiac magnetic resonance, while underutilized in these cases, proved valuable in the literature for comprehensive structural assessment without radiation exposure. Echocardiography remains the primary diagnostic tool for Criss-Cross Heart, while cardiac catheterization, angiography, and advanced imaging like MRI offer supplementary anatomical insights critical for surgical interventions. Early and precise imaging-driven diagnosis and management significantly contribute to favorable long-term outcomes, underscoring the importance of an integrated imaging approach in managing CCH.