title: Bodily isomerism is an independent risk factor for pulmonary hypertension in adults with congenital heart disease.
abstract: Bodily isomerism, or heterotaxy is a unique entity on which there is mirror imagery in various organ systems, leading to a deviation from the normal lateral arrangements of the viscera. Adults with such isomerism and associated congenital malformations of the heart are now reaching adulthood and developing long-term complications. This study investigates the prevalence and characteristics of pulmonary hypertension in adults with isomerism.
  
  
  
  The 2012 iteration of the Nationwide Inpatient Sample was utilized and patients were identified as having or not having bodily isomerism and having or not having pulmonary hypertension. Univariate analysis utilizing Chi-square tabulation was done to assess characteristics associated with pulmonary hypertension. Next, a multivariate analysis was done on all patients to identify predictors of pulmonary hypertension followed by a multivariate analysis of patients with only isomerism to identify predictors of pulmonary hypertension specific to this subset.
  
  
  
  A total of 6,907,109 admissions were included in the analysis. Of these, 861 had isomerism (0.01%). Of those with isomerism, 5.6% were found to have pulmonary hypertension. When all patients were included in the multivariate analysis, isomerism was found to be an independent risk factor for pulmonary hypertension with an odds ratio of approximately 1.79. When only patients with isomerism were included in the multivariate analysis, advanced age, obesity, and history of anomalous pulmonary venous connection were independent risk factors of pulmonary hypertension.
  
  
  
  Pulmonary hypertension is more common in those with isomerism, with isomerism being an independent risk factor for pulmonary hypertension. The prevalence of pulmonary hypertension is 5.6% in the setting of isomerism. Independent risk factors for pulmonary hypertension in patients with isomerism include age, obesity, and history of anomalous pulmonary venous connection.
authors.affiliation: Children's Hospital of Wisconsin/Medical College of Wisconsin, 9000 Wisconsin Avenue, Milwaukee, WI, 53226, USA Loomba.rohit@gmail.com.
authors.forename: Rohit S
authors.initials: RS
authors.lastname: Loomba
authors.affiliation: Creighton University Medical Center, Omaha, NE, USA.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Aggarwal
authors.affiliation: Chicago Medical School, Chicago, IL, USA.
authors.forename: Rohit R
authors.initials: RR
authors.lastname: Arora
authors.affiliation: Institute of Genetic Medicine, Newcastle Upon Tyne, United Kingdom.
authors.forename: Robert
authors.initials: R
authors.lastname: Anderson
mesh_terms: D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications*; D059446:Heterotaxy Syndrome / Q000150:complications*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012587:Scimitar Syndrome / Q000453:epidemiology
keywords: atrioventricular septal defect; congenital heart disease; double outlet right ventricle; heterotaxy; isomerism; malformations; pulmonary hypertension