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Korean Circulation Journal Oct 2013Situs inversus of the abdominal organs in the presence of normally placed heart on the left side of the thorax is known as situs inversus with isolated levocardia. This...
Situs inversus of the abdominal organs in the presence of normally placed heart on the left side of the thorax is known as situs inversus with isolated levocardia. This rare condition is commonly associated with severe congenital defects of the heart. We report a case of situs inversus with levocardia in a 19-year-old asymptomatic male patient with completely normal heart on the left chest. Spiral computed tomography of the thorax and abdomen and echocardiographic studies revealed situs inversus of abdominal organs, normal heart (levocardia), mirrored left lungs, a midline liver, a left-sided inferior vena cava connecting to the right atrium, multiple splenic masses in the abdominal right upper quadrant, and aneurysmal dilatation of a splenic artery.
PubMed: 24255657
DOI: 10.4070/kcj.2013.43.10.705 -
European Spine Journal : Official... Dec 2009The objective of this study was to evaluate the coronal alignment of the thoracic spine in persons with dextrocardia. Generally, the thoracic spine is slightly curved to...
The objective of this study was to evaluate the coronal alignment of the thoracic spine in persons with dextrocardia. Generally, the thoracic spine is slightly curved to the right. It has been suggested that the curve could be triggered by pulsation forces from the descending aorta. Since no population study has focused on the alignment of the thoracic spine in persons with situs inversus, dextrocardia, and right-sided descending aorta, we compared the radiographs of the thoracic spine in persons with dextrocardia to those having normal levocardia. Among 57,440 persons in a health survey, 11 cases of dextrocardia were identified through standard radiological screening. The miniature chest radiographs of eight persons were eligible for the present study. The study was carried out as a nested case-control study. Four individually matched (age, gender, and municipality) controls with levocardia were chosen for each case. Coronal alignment of the thoracic spine was analyzed without knowledge of whether the person had levo- or dextrocardia. A mild convexity to the left was found in all persons with dextrocardia and right-sided descending aorta (mean Cobb angle 6.6 degrees to the left, SD 2.9). Of the 32 normal levocardia persons, 29 displayed a convexity to the right, and the remaining three had a straight spine (mean Cobb angle 5.2 degrees to the right, SD 2.3). The difference (mean 11.8 degrees , SD 3.5) differed significantly from unity (P = 0.00003). In conclusion, it seems that a slight left convexity of the thoracic spine is frequent in dextrocardia. We assume that the effect of the repetitive pulsatile pressure of the descending thoracic aorta, and the mass effect of the heart may cause the direction of the convexity to develop opposite to the side of the aortic arch.
Topics: Adult; Aged; Aorta, Thoracic; Blood Pressure; Case-Control Studies; Comorbidity; Dextrocardia; Disability Evaluation; Female; Functional Laterality; Humans; Male; Middle Aged; Radiography; Spinal Curvatures; Thoracic Vertebrae; Young Adult
PubMed: 19506918
DOI: 10.1007/s00586-009-1049-y -
Cardiology Research Dec 2015We present a case of a 19-year-old female presenting with cyanosis since birth. The major anomaly demonstrated was a "triply twisted heart" with a balanced physiology,...
We present a case of a 19-year-old female presenting with cyanosis since birth. The major anomaly demonstrated was a "triply twisted heart" with a balanced physiology, allowing her to survive into adulthood. Non-invasive imaging was done using 2D and real-time 3D (or 4D) echocardiography with multi-slice imaging from 4D volume datasets. Findings were confirmed using cardiac magnetic resonance imaging (MRI). A segmental approach revealed atrial and visceral situs inversus, levocardia, atrioventricular discordance, and ventriculoarterial discordance. Both the aorta and pulmonary artery were malposed and arise from the right ventricle (double outlet right ventricle or DORV). There was also a complete atrioventricular septal defect (CAVSD) associated with a functional single atrium and a functional univentricle (single ventricle). Other findings include a severe pulmonic stenosis (PS), preserved right and left ventricular systolic function, and a normal pulmonary arterial pressure. She also had a persistent left superior vena cava (SVC) that drains into the morphologic right atrium, while the right-sided SVC drains into the morphologic left atrium. A multidisciplinary team deemed that management be palliative. She is on regular follow-up at our clinics for non-invasive monitoring. To our knowledge, this is the first reported case in an adult with this combination of anomalies.
PubMed: 28197259
DOI: 10.14740/cr440w -
Wideochirurgia I Inne Techniki... Aug 2012The article presents a case of an adrenal adenoma (Conn's syndrome) in a 50-year-old man with situs inversus with levocardia. Laparoscopic adrenalectomy was performed...
The article presents a case of an adrenal adenoma (Conn's syndrome) in a 50-year-old man with situs inversus with levocardia. Laparoscopic adrenalectomy was performed and the patient made a full recovery. It has been concluded that diagnostic assessment by means of imaging techniques providing details of the organ anatomy and the experience of the medical team are the key factors determining the outcome of such surgery.
PubMed: 23256030
DOI: 10.5114/wiitm.2011.25973 -
BMJ Case Reports Apr 2022
Topics: Congenitally Corrected Transposition of the Great Arteries; Humans; Levocardia; Situs Inversus; Tomography, X-Ray Computed; Transposition of Great Vessels
PubMed: 35428663
DOI: 10.1136/bcr-2021-245839 -
Experimental and Therapeutic Medicine Feb 2016The present study describes the case of a 2.5-year-old girl with double patent ductus arteriosus (PDA) that was successfully treated following interventional and...
The present study describes the case of a 2.5-year-old girl with double patent ductus arteriosus (PDA) that was successfully treated following interventional and surgical treatment. Bilateral ductus arteriosus is a very rare condition, which is assumed to occur when the branchial-type arterial system transforms into the mammalian-type arterial system during the development of the aorta and its branches. This case was misdiagnosed as ordinary PDA by echocardiography prior to the first surgery and the surgery was not successful because of poor accessibility. Enhanced computed tomography subsequently showed situs solitus, atrial situs, levocardia, right-sided aortic arch with right-sided descending aorta, an isolated left subclavian artery and double PDA. Interventional treatment was performed and intraoperative aortic arch angiography showed that the descending aorta was the origin of the first funnel-type PDA (PDA-1). The left subclavian artery was not connected to the aorta but was connected to the pulmonary artery with a very narrow winding duct, which was PDA-2. Interventional treatment via PDA-2 also failed because passing a guidewire through the twisted PDA-2 was difficult. The child was immediately transferred to the surgical operation room for double PDA ligation and left subclavian artery reconstruction under median thoracotomy. The surgical procedure succeeded and the patient recovered quickly. The failure of the interventional treatment may be attributed to the difficulty in establishing a path. The soft tip of the hardened guidewire was relatively long. If the hardened part of the wire was sent to the appropriate place to support the pathway, the soft tip would be forced to enter the vertebrobasilar artery system. A similar problem was encountered when the left subclavian artery was selected for intervention. Shortening the length of the soft tip of the hardened guidewire may have enabled smooth completion of the establishment of the pathway. However, this type of hardened guidewire requires specific production.
PubMed: 26893638
DOI: 10.3892/etm.2015.2916 -
Journal of Cardiology Cases Jul 2013Percutaneous coronary intervention in patients with dextrocardia presents several challenges due to abnormal location of the heart, mirror image pattern of aortic arch...
Percutaneous coronary intervention in patients with dextrocardia presents several challenges due to abnormal location of the heart, mirror image pattern of aortic arch and its branches, and abnormal coronary origin and orientation. The challenges involve appropriate choice of vascular access, guiding catheters, engagement technique, acquisition and interpretation of radiological orientation of coronary anatomy, and appropriate radiological angles and views. We report a patient with dextrocardia and situs inversus who presented with acute ST segment elevation myocardial infarction and was successfully treated with trans-radial primary percutaneous coronary intervention using "double inversion technique." We also emphasize that left radial artery approach may be technically preferred to right radial artery approach due to mirror image aortic arch branching pattern. < 1. Percutaneous coronary intervention in patients with dextrocardia presents several challenges due to abnormal location of the heart, mirror image pattern of aortic arch and its branches, and abnormal coronary origin and orientation. 2. These challenges can be overcome by "double inversion technique," which allows the operator to interpret coronary anatomy and perform intervention as in levocardia.>.
PubMed: 30546734
DOI: 10.1016/j.jccase.2013.03.010 -
Antenatal ultrasound diagnosis of small bowel non-rotation in complex left isomerism: a case report.International Journal of Surgery Case... 2019A multiparous expectant mother was referred to our tertiary unit at 23 weeks with a complex fetal cardiac anomaly in the context of suspected heterotaxy syndrome. The...
PRESENTATION OF CASE
A multiparous expectant mother was referred to our tertiary unit at 23 weeks with a complex fetal cardiac anomaly in the context of suspected heterotaxy syndrome. The cardiac findings were consistent with isomerism: the fetal cardiac position was levocardia with a single functioning double outlet ventricle and AV valve, pulmonary stenosis, and interrupted inferior vena cava (IVC) with azygous continuation. The fetal abdominal situs was also altered, with the stomach to the right, and the hepatobiliary system midline to left. The spleen was not identified antenatally or postnatally. At 36 weeks, ultrasound revealed an abnormal bowel pattern with small bowel loops on the right side of the abdomen and large bowel on the left, suggesting a diagnosis of non- rotation. The infant was delivered vaginally at 39 weeks. The cardiac diagnosis and non-rotation of the small bowel were confirmed by postnatal echocardiography and contrast fluoroscopy.
DISCUSSION
Heterotaxy syndrome is traditionally classified into right or left isomerism depending on how and where the organs are anatomically arranged. The case presented here demonstrates mixed laterality and prenatal ultrasound features of non-rotation.
CONCLUSION
It is important to be informed of the embryological variants of isomerism and actively seek antenatal evidence of bowel non-rotation in such cases.
PubMed: 30822676
DOI: 10.1016/j.ijscr.2018.11.069 -
Journal de Gynecologie, Obstetrique Et... Sep 2012The position or location of the organs and vessels is usually classified into three types: situs solitus, situs inversus, and situs ambigus. Situs solitus is the usual... (Review)
Review
The position or location of the organs and vessels is usually classified into three types: situs solitus, situs inversus, and situs ambigus. Situs solitus is the usual arrangement of organs and vessels within the body. Only 0.6 to 0.8% of patients with situs solitus and levocardia have associated congenital heart diseases. Situs inversus refers to an anatomic arrangement that is the mirror image of situs solitus. The incidence of congenital heart disease is increased to 3 to 5% in the patients with situs inversus. The patients with heterotaxy have congenital heart disease in high incidence, ranging from 50 to nearly 100%. We present four cases diagnosed in our department in a period of 18 months. With these four cases and a review in the literature, we explore the definitions and characteristics of heterotaxy syndromes and we study the role of 3D ultrasound.
Topics: Female; Heart Defects, Congenital; Heterotaxy Syndrome; Humans; Male; Ultrasonography
PubMed: 22704359
DOI: 10.1016/j.jgyn.2012.04.015 -
Echocardiography (Mount Kisco, N.Y.) Oct 2013Echocardiographic image quality in Fontan survivors may be limited by a variety of factors. We sought to describe echocardiographic quality and factors associated with... (Clinical Trial)
Clinical Trial
Echocardiographic image quality in Fontan survivors may be limited by a variety of factors. We sought to describe echocardiographic quality and factors associated with study quality in subjects participating in the Pediatric Heart Network Fontan Cross-Sectional Study. Echocardiograms were obtained at 7 clinical sites using a standard protocol. Quality grading and analysis were performed by a core laboratory. Univariate and multivariable modeling were performed to assess factors associated with quality and ability to obtain images sufficient for prespecified quantitative analysis. A total of 543 echocardiograms were obtained. The quality of echocardiograms improved over the duration of the study. The great arteries, systemic veins, and pulmonary veins were less likely to be adequately imaged than other cardiac structures. Quantitative analysis of ventricular volume was possible in 76% overall, but only 41% of those with mixed ventricular morphology. Factors independently associated with better quality included younger age, levocardia, acquisition of the echocardiogram at a longer time since the beginning of enrollment, absence of a pulmonary artery stent, and clinical site. Patient and center-specific factors are associated with echocardiographic quality after the Fontan procedure. Increased familiarity and experience with a standard imaging protocol is likely to result in improved quality.
Topics: Adolescent; Child; Cross-Sectional Studies; Echocardiography; Female; Fontan Procedure; Heart Defects, Congenital; Humans; Incidence; Male; Postoperative Complications; Reproducibility of Results; Risk Factors; Sensitivity and Specificity; Treatment Outcome; United States
PubMed: 23614708
DOI: 10.1111/echo.12219