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Annals of Medicine and Surgery (2012) Dec 2021Obesity is a worldwide pandemic and is closely associated with an increased risk of comorbidities and overall mortality. Surgery has emerged as an essential strategy to...
INTRODUCTION AND IMPORTANCE
Obesity is a worldwide pandemic and is closely associated with an increased risk of comorbidities and overall mortality. Surgery has emerged as an essential strategy to ameliorate obesity-attributable comorbidities and as a powerful weight-loss tool. Due to the increasing number of obese patients predicted to elect surgery, individuals with rare anomalies such as situs inversus can be expected.
CASE PRESENTATION
We present the case of a 49-year-old woman with situs inversus with levocardia. She had a high BMI and was admitted for bariatric surgery. After several adjustments to our technique, the procedure was completed without complications.
CLINICAL DISCUSSION
Laparoscopic bariatric surgeries are highly demanding; variations from the normal anatomy could challenge the medical team.
CONCLUSION
Preoperative diagnosis and highly trained surgeons is of paramount importance to adequately treat every patient.
PubMed: 34840772
DOI: 10.1016/j.amsu.2021.102972 -
European Heart Journal. Case Reports Jul 2021Cryoballoon-based pulmonary vein isolation (cbPVI) is a standardized treatment of atrial fibrillation. In complex anatomies, radiofrequency ablation (rfPVI) is usually...
BACKGROUND
Cryoballoon-based pulmonary vein isolation (cbPVI) is a standardized treatment of atrial fibrillation. In complex anatomies, radiofrequency ablation (rfPVI) is usually preferred. We describe the first cbPVI in a rare patient with SI and levocardia.
CASE SUMMARY
A 41-year-old male patient with paroxysmal atrial fibrillation was referred to our clinic after a previous, unsuccessful cbPVI procedure. Observation of an atypical lead-wire position due to an abnormal anatomy of the inferior vena cava led to its initial termination. A subsequent thoraco-abdominal computed tomography revealed situs inversus abdominalis and levocardia and the procedure was re-attempted in our clinic. Transseptal puncture (TSP) was guided via transoesophageal echocardiography and fluoroscopy, using a SL0-Sheath and a standard BRK-needle. Advancement of the sheath initially failed but after additional dilatation with an Inoue dilator, transseptal passage of the sheath was successful. Due to the unusual antero-cranial TSP, the septal pulmonary veins (PV) contrasted poorly. After repeat TSP, a steerable FlexCath Advance sheath was introduced into the left atrium using an Amplatz Super Stiff guidewire. Subsequently, all PV were intubated with the Achieve catheter, over which a 2nd generation cryoballoon was introduced. Despite the practical challenges in this case, all PV were isolated.
DISCUSSION
The main challenges include the achievement of transseptal access and manipulation of the cryoballoon to achieve a patent seal of the pulmonary veins. cbPVI eliminates the need for constant re-positioning of the ablation catheter and might facilitate the creation of durable lesions under such difficult anatomical conditions.
PubMed: 34240004
DOI: 10.1093/ehjcr/ytab245 -
The Journal of Maternal-fetal &... Dec 2022We retrospectively analyzed our center's experience with the prenatal diagnosis of isolated perimembranous ventricular septal defects that underwent primary surgical...
OBJECTIVE
We retrospectively analyzed our center's experience with the prenatal diagnosis of isolated perimembranous ventricular septal defects that underwent primary surgical repair in infancy.
METHODS
We identified patients born in Southern Nevada, between October 2012 and October 2020, with prenatal care that underwent surgical closure of an isolated large perimembranous ventricular septal defect between 1 and 12 months of age. The description at surgery defined ventricular septal defect morphology. We included only those with situs solitus, levocardia without dextroposition, and without any other cardiovascular abnormality. We analyzed prenatal detection rates for each of the eight years.
RESULTS
We identified 81 patients. Of the 81, 35 (43%) had trisomy 21. We identified no other aneuploidies in those that underwent surgical repair; however, 1 had a 15q13.3 deletion syndrome, and 1 had a 22 q11.2 deletion syndrome. Of the 81, 27 (33%) overall were prenatally diagnosed. Increasing prenatal detection rates strongly correlated with time ( = 0.92, = .002).
CONCLUSIONS
Trisomy 21 is common in isolated perimembranous ventricular septal defects undergoing primary repair in infancy. Further, prenatal detection rates significantly improved over time, up to 65% detection in the current years.
Topics: Pregnancy; Female; Humans; Retrospective Studies; Down Syndrome; Heart Septal Defects, Ventricular; Prenatal Diagnosis
PubMed: 34139939
DOI: 10.1080/14767058.2021.1940933 -
Journal of Cardiovascular Echography 2020A newborn without prenatal diagnosis, with bronchial and abdominal situs inversus in levocardia, was referred to our hospital for accurate evaluation; echocardiography...
A newborn without prenatal diagnosis, with bronchial and abdominal situs inversus in levocardia, was referred to our hospital for accurate evaluation; echocardiography showed venoatrial connections in mirror-image arrangement, atrioventricular (AV) discordance, and double-outlet right ventricle (DORV). Additional cardiac malformations were double upper caval district, atrial communication, subpulmonary interventricular communication, and moderate subvalvular and valvular pulmonary stenosis. Few days after birth, the patient presented low oxygen saturation and the heart team decided for a palliative surgery. We describe a very rare case in a newborn with bronchial-abdominal mirror imagery, AV discordance, and DORV in levocardia.
PubMed: 33828947
DOI: 10.4103/jcecho.jcecho_65_20 -
Journal of Medical Case Reports Mar 2021Bilateral congenital diaphragmatic hernia (CDH) is very rare. A few studies have reported the pathogenic role of 5p in CDH.
BACKGROUND
Bilateral congenital diaphragmatic hernia (CDH) is very rare. A few studies have reported the pathogenic role of 5p in CDH.
CASE PRESENTATION
A 23-year-old primigravida Japanese woman was referred for the following abnormal findings at 33 weeks of gestation: polyhydramnios, macroglossia, talipes equinovarus, and levocardia. A marker chromosome was detected by amniocentesis. Fluorescence in situ hybridization with whole chromosome paint 5 and nucleolus organizer region probes confirmed its origin from chromosome 5 and an acrocentric chromosome. The karyotype of the fetus was diagnosed as 47, XY, +mar. ish +mar(WCP5+). At 39 + 5 weeks, a 2462 g male infant was delivered, with a specific facial configuration. Bilateral CDH, hypoplasia of the corpus callosum, atrial septal defect, and hypothyroidism were also detected in the baby. The karyotype of the peripheral blood was consistent with that of the amniocentesis.
CONCLUSION
Genes coded on 5p might be associated with the pathogenesis of CDH; however, further investigation is required.
Topics: Adult; Female; Hernias, Diaphragmatic, Congenital; Humans; In Situ Hybridization, Fluorescence; Infant; Male; Mosaicism; Pregnancy; Prenatal Diagnosis; Trisomy; Young Adult
PubMed: 33750440
DOI: 10.1186/s13256-021-02710-y -
Cureus Jan 2021An unroofed coronary sinus is a rare congenital anomaly in the roof of the coronary sinus causing a communication between the coronary sinus and the left atrium leading...
An unroofed coronary sinus is a rare congenital anomaly in the roof of the coronary sinus causing a communication between the coronary sinus and the left atrium leading to a left to right shunt. It is often associated with a persistent left superior vena cava and other complex congenital lesions like anomalous pulmonary venous return and heterotaxy. Since it is a deep-seated defect, it is seldom diagnosed by transthoracic two-dimensional (2D) echocardiography and requires multimodal imaging for a diagnosis. Here, we present the case of a 27-year-old male in whom the defect was very apparent on standard 2D transthoracic echocardiography. Transthoracic 2D echocardiography revealed situs solitus, levocardia, and a dilated coronary sinus with unroofing which was most prominent in the standard parasternal long-axis view and the foreshortened apical four-chamber view. A color Doppler demonstrated a flow from the left atrium into the dilated coronary sinus. The right ventricle and atrium were dilated with mild pulmonary arterial hypertension. There was no right ventricular dysfunction. Examination with modified suprasternal views showed a left superior vena cava. All four pulmonary veins drained into the left atrium. Other chambers of the heart and great vessels were structurally normal without coarctation or patent ductus arteriosus. The interventricular septum was intact and atrioventricular and ventriculoatrial concordance was preserved. Detection of a dilated coronary sinus by transthoracic 2D echocardiography must be followed by multimodal imaging techniques like cardiac computed tomography and transesophageal echocardiography to detect and manage associated defects.
PubMed: 33680587
DOI: 10.7759/cureus.13041 -
Journal of Cardiac Surgery Apr 2021We reviewed our center's isolated vascular ring data.
OBJECTIVE
We reviewed our center's isolated vascular ring data.
METHODS
Inclusion criteria were patients born in Nevada between June 2015 and July 2020 with situs solitus, levocardia, atrioventricular and ventriculoarterial concordance, and no significant intracardiac malformations.
RESULTS
We identified 95 patients. Of the 95, 56 (59%) were female (p = .033). For the study period, there were approximately 180,000 live births, for a prevalence of 5.3 isolated vascular rings per 10,000 live births. Of the 95, 78 (82%) were prenatally diagnosed. Of the 95, 63 (66%) were products of high-risk pregnancies (p = .0001). Additionally, we found advanced maternal age was an isolated vascular ring risk factor (relative risk ratio, 2.7; 95% confidence interval, 1.8, 4.1; p < .00001).
CONCLUSIONS
Isolated vascular rings are relatively common cardiovascular malformations and more common in females. High prenatal detection rates are achievable. Further, the majority with isolated vascular rings are products of high-risk pregnancies, and advanced maternal age is a statistically significant occurrence risk factor.
Topics: Cardiovascular Abnormalities; Female; Humans; Male; Pregnancy; Prenatal Diagnosis; Prevalence; Risk Factors; Vascular Ring
PubMed: 33586208
DOI: 10.1111/jocs.15414 -
Journal of Nuclear Medicine Technology Dec 2020Imaging of dextrocardia in humans requires an understanding of the orientation of the heart chambers and walls. There are many types of cardiac malpositioning, such as...
Imaging of dextrocardia in humans requires an understanding of the orientation of the heart chambers and walls. There are many types of cardiac malpositioning, such as dextrocardia (with or without situs inversus), mesocardia, and levocardia. Myocardial perfusion scintigraphy of dextrocardia has been explained in case reports and imaging atlases; however, myocardial viability assessment using nuclear medicine imaging techniques is less documented in the literature. In 2 cases of dextrocardia with situs inversus and 1 case of mesocardia, myocardial viability was assessed using Tc-sestamibi rest perfusion scintigraphy and F-FDG PET. Cardiac SPECT images of dextrocardia with situs inversus were acquired using the feet-first supine position with a 180° arc from left anterior oblique to right posterior oblique, whereas a right-lateral-to-left-lateral arc was used for mesocardia. The processing and reconstruction were done by entering the dataset for the feet-first supine position and repeating after entering the dataset for the feet-first prone position. The 2 sets of reconstructed images were compared for orientation of walls and cardiac chambers. The first processing, using the feet-first supine position, revealed an interchanged septum and lateral wall in reconstructed images of dextrocardia with situs inversus. This interchange was corrected by changing the position to prone during processing of the rest perfusion and PET raw data. The display of cardiac slices in various axes matched the conventional nomenclature for the septum and lateral wall, leading to easy interpretation. However, this change was not required in the mesocardia, for which the location of the heart chambers was not interchanged. Because the acquisition protocol for SPECT is a semicircular orbit, the various types of dextrocardia require careful selection of the arc, with the patient positioning kept feet-first supine. Processing and reconstruction of data by changing the patient position to prone was found to be most useful method of matching the septum and lateral wall orientation for interpretation of images.
Topics: Dextrocardia; Female; Humans; Male; Middle Aged; Myocardium; Nuclear Medicine; Positron-Emission Tomography; Technetium Tc 99m Sestamibi; Tissue Survival; Tomography, Emission-Computed, Single-Photon
PubMed: 32887761
DOI: 10.2967/jnmt.120.248435 -
A&A Practice Aug 2020
Intraoperative Transesophageal Echocardiography in a Rare Case of Situs Inversus, Levocardia, and Congenitally Corrected Transposition of Great Arteries: A Sequential Segmental Analysis.
Topics: Arteries; Congenitally Corrected Transposition of the Great Arteries; Echocardiography, Transesophageal; Humans; Levocardia; Situs Inversus
PubMed: 32845108
DOI: 10.1213/XAA.0000000000001297 -
Journal of Cardiac Surgery Oct 2020We present a case of a 12-year-old boy with discordance between the atrial arrangement and the thoracoabdominal arrangement in the setting of twisted atrioventricular...
We present a case of a 12-year-old boy with discordance between the atrial arrangement and the thoracoabdominal arrangement in the setting of twisted atrioventricular connections. This case highlights the importance of a separate description of all visceral organs and venous drainage for an accurate description of visceroatrial arrangement in cases of congenital heart defects.
Topics: Abnormalities, Multiple; Child; Computed Tomography Angiography; Heart Atria; Heart Septal Defects, Atrial; Heart Septal Defects, Ventricular; Heart Ventricles; Humans; Levocardia; Male; Pulmonary Valve Stenosis
PubMed: 32652587
DOI: 10.1111/jocs.14848