Criss-cross heart with straddling right atrioventricular valve.

Angiocardiographic appearance of a criss-cross heart with straddling tricuspid valve has been presented. Atrial situs was normal and the right atrium was connected to the morphological right ventricle situated superiorly and to the left of the left ventricle. The left atrium was connected to the morphological left ventricle situated inferiorly and to the right of the right ventricle. The interventricular septum was horizontal in position. Both great arteries arose from the right ventricle with the anterior aorta. The case was concluded as a criss-cross heart with concordant atrioventricular (A-V) connection and double outlet right ventricle (DORV). Straddling of the right A-V valve was recognized in another institution by two-dimensional (2-D) echocardiography and confirmed by right atrial angiography in our institution. The value of combined investigation with selective four-chamber angiography, especially including right atrial angiography and 2-D echocardiography in the diagnosis of such complex cardiac anomalies has been stressed.