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Dextrocardia is a rare congenital malformation in which the heart is located in the right hemithorax, with an incidence of around 1 in 12,000. Dextrocardia usually remains asymptomatic until accidentally diagnosed through echocardiography and chest radiography, which are mostly performed for other reasons. The complex heart anatomy in dextrocardia can pose great challenges, particularly in patients requiring surgical interventions. In this case presentation, we aimed to emphasize that a multidisciplinary approach is recommended in managing patients with dextrocardia. A 54-year-old female patient arrived with nausea, vomiting, fatigue, and tremor complaints. Medical evaluations revealed bradycardia, which developed after the use of propranolol for a panic attack. The patient underwent an angiography due to the existence of non-ST elevation myocardial infarction and Wenckebach's atrioventricular block, which showed the deviation of the left coronary artery to the right and of the right coronary artery to the left, raising suspicion of dextrocardia. Chest radiography confirmed the presence of dextrocardia. The patient received the necessary treatment, since dextrocardia poses minimal risk, the patient was discharged with follow-up recommendations. [ABSTRACT FROM AUTHOR]

Background: A heart positioned on the right side of the thorax can be more a complex situation than it seems, also the potentially associated congenital cardiopathies are variable. In this regard, patients with dextrocardia presenting with complete atrioventricular block require a thorough anatomical investigation to map the veno-arterial system and potential cardiovascular defects before proceeding with a permanent pacing procedure. Case presentation: A 73-year-old Caucasian woman with no significant medical history presented with syncope. Physical examination showed regular heart sounds with an average heart rate of 35–40 beats per minute and no other relevant physical findings. Chest X-rays revealed a heart positioned in the right hemithorax. A standard electrocardiogram revealed complete atrioventricular block with junctional escape rhythm at nearly 35–40 beats per minute. A transthoracic echocardiogram showed a mirror image dextrocardia without any other remarkable abnormalities. Venogram performed using the left peripheral cephalic vein showed normal venous return into the right atrium positioned on the left side. Surgical intervention consisted of permanent dual chamber pacemaker implantation using the left subclavian vein. Discussion is provided based on the relevant medical literature outlining different potential scenarios with associated cardiac and major vessels abnormalities. Conclusion: This case highlights an atypical presentation of atrioventricular block in a patient with dextrocardia and situs inversus, for whom a successful dual-pacemaker implantation procedure was performed. [ABSTRACT FROM AUTHOR]

Background Cardiac interventions may be challenging in patients with congenital cardiac abnormalities. This case reports cardiac resynchronization therapy pacemaker (CRT-P) implantation and single catheter ablation of atrioventricular node (AVN) with remote magnetic navigation (RMN) via peripheral vascular access in a patient with Kartagener's syndrome and permanent atrial fibrillation (AF). Case summary A 74-year-old male with situs inversus presented for treatment of permanent AF and severe heart failure. In echocardiography, left ventricular ejection fraction was 30%, and there was severe dyskinesia due to a left bundle branch block. After successful CRT-P implantation, we performed AVN ablation because biventricular (BiV) pacing was <75% despite maximal rate control medication. The ablation catheter was inserted from the right basilic vein, and no other catheters were used. Despite peripheral vascular access, manipulation of the ablation catheter with RMN was easy, and the ablation was successful. After the ablation, BiV pacing instantly increased to 100%, and left ventricular function and symptomatic status improved gradually. Conclusions Cardiac resynchronization therapy pacemaker implantation and RMN-guided single catheter ablation of the AVN in a patient with dextrocardia via peripheral vascular access was effective and safe. The use of RMN and peripheral vascular access may offer important advantages also in other patient groups. [ABSTRACT FROM AUTHOR]

Copyright of Saudi Medical Journal is the property of Saudi Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background A heart positioned on the right side of the thorax can be more a complex situation than it seems, also the potentially associated congenital cardiopathies are variable. In this regard, patients with dextrocardia presenting with complete atrioventricular block require a thorough anatomical investigation to map the veno-arterial system and potential cardiovascular defects before proceeding with a permanent pacing procedure. Case presentation A 73-year-old Caucasian woman with no significant medical history presented with syncope. Physical examination showed regular heart sounds with an average heart rate of 35–40 beats per minute and no other relevant physical findings. Chest X-rays revealed a heart positioned in the right hemithorax. A standard electrocardiogram revealed complete atrioventricular block with junctional escape rhythm at nearly 35–40 beats per minute. A transthoracic echocardiogram showed a mirror image dextrocardia without any other remarkable abnormalities. Venogram performed using the left peripheral cephalic vein showed normal venous return into the right atrium positioned on the left side. Surgical intervention consisted of permanent dual chamber pacemaker implantation using the left subclavian vein. Discussion is provided based on the relevant medical literature outlining different potential scenarios with associated cardiac and major vessels abnormalities. Conclusion This case highlights an atypical presentation of atrioventricular block in a patient with dextrocardia and situs inversus, for whom a successful dual-pacemaker implantation procedure was performed.

Benign situs inversus totalis of the viscerum is often diagnosed accidentally, rarely in adults, and more frequently in children and neonates, affecting both sexes. In this report, a young female patient accidentally discovered a situs inversus totalis after computed tomography for acute abdominal pain. In this uncommon anatomical abnormality, the major visceral organs are reversed in the opposite direction. This report highlights the importance of being aware of and considering situs inversus in clinical practice, particularly when interpreting imaging findings and planning medical procedures. This is critical for differential diagnosis and comorbidities that may affect those patients. The cause of situs inversus totalis is still unknown; however, this condition is frequently asymptomatic, particularly in infants, and is sometimes associated with other syndromes. The patient arrived at the emergency department with left flank pain, nausea, and fever. In the first ultrasonography, a strange anatomy was suspected; thus, a contrasted computed tomography was performed. The patient had never had a computed tomography scan before. The identification of situs inversus totalis was unexpected and coincidental; the computed tomography images were carefully examined. In patients with chest or abdominal pain, clinicians may consider situs inversus totalis based on computed tomography, particularly if without clinical and imaging history. This knowledge can help in the differential diagnosis, avoiding unneeded interventions. Moreover, comorbidities that affect several systems, particularly cardiovascular and pulmonary systems, affect quite a few patients with situs inversus totalis, who require careful examination and lifelong monitoring.

We present the case of a 52-year-old female patient on optimal medical therapy (OMT) for heart failure with severely reduced ejection fraction. She was diagnosed with dextrocardia and congenital corrected transposition of the great arteries (ccTGA) by echocardiography. Despite 3 months of OMT and a persisting NYHA II functional state, she was referred for primary prevention ICD implantation. At admission echocardiography revealed a hypertrophic systemic ventricle with an ejection fraction of 27%. Cardiac CT confirmed ccTGA, dextrocardia, a normal extracardiac and epicardial venous system. Coronary artery disease was excluded. Our team opted for left-sided VDD-ICD implantation in case of a need for AV-synchronous pacing and to enhance arrhythmia discrimination. An active fixation shock lead was placed in the mid-septal region of the functional right ventricle. The defibrillation threshold test (DFT) was successful at 20 J. No periprocedural complications were observed. At the 12-month ambulatory visit, device interrogation showed good function, no detected arrhythmias, and no antitachycardia therapy was delivered. Preoperative imaging is essential prior to any invasive cardiac procedure in patients with congenital heart disease. Performing a DFT test at adult congenital heart disease patients may be reasonable.

Background: Phlebectasia is a term used for the dilatation of a vein without tortuosity. Rarely, the condition may affect the internal jugular vein (IJV), causing prominence in the neck, which may be confused with other neck swellings. Clinical Description: A 6-year-old boy presented with bilateral episodic swelling in the neck noticed since 2 years of age and a hoarse voice since 3 years of age. On examination, the neck swelling was soft, cystic, compressible, nontender, and nonpulsatile, increasing in size by all maneuvers increasing intrathoracic pressure. Systemic examination revealed the apex beat was on the right side, and the liver was palpable below the left subcostal margin. Management and Outcome: The workup for tuberculosis was negative, and direct laryngoscopy was normal. X-ray of the chest with abdomen showed dextrocardia and stomach shadow on the right side. Color Doppler revealed nontortuous dilatation of both IJVs. Dynamic computed tomography venography confirmed the diagnosis of bilateral IJV phlebectasia (IJVP). The child was started on speech therapy. The mother was counseled regarding the benign nature of the disease and advised regular follow-up. The child had no complications, and his voice improved with speech therapy at 1-year follow-up. Conclusion: Pediatricians should be aware that IJVP may rarely be the cause of neck swelling associated with hoarseness of voice. Increase in the size of the swelling with Valsalva maneuvers and color Doppler ultrasound helps to confirm the diagnosis.

Abstract To evaluate the genetic etiology of fetal dextrocardia, associated ultrasound anomalies, and perinatal outcomes, we investigated the utility of whole exome sequencing (WES) for prenatal diagnosis of dextrocardia. Fetuses with dextrocardia were prospectively collected between January 2016 and December 2022. Trio-WES was performed on fetuses with dextrocardia, following normal karyotyping and/or chromosomal microarray analysis (CMA) results. A total of 29 fetuses with dextrocardia were collected, including 27 (93.1%) diagnosed with situs inversus totalis and 2 (6.9%) with situs inversus partialis. Cardiac malformations were present in nine cases, extra-cardiac anomalies were found in seven cases, and both cardiac and extra-cardiac malformations were identified in one case. The fetal karyotypes and CMA results of 29 cases were normal. Of the 29 cases with dextrocardia, 15 underwent WES, and the other 14 cases refused. Of the 15 cases that underwent WES, clinically relevant variants were identified in 5/15 (33.3%) cases, including the diagnostic variants DNAH5, DNAH11, LRRC56, PEX10, and ZIC3, which were verified by Sanger sequencing. Of the 10 cases with non-diagnostic results via WES, eight (80%) chose to continue the pregnancies. Of the 29 fetuses with dextrocardia, 10 were terminated during pregnancy, and 19 were live born. Fetal dextrocardia is often accompanied by cardiac and extra-cardiac anomalies, and fetal dextrocardia accompanied by situs inversus is associated with a high risk of primary ciliary dyskinesia. Trio-WES is recommended following normal karyotyping and CMA results because it can improve the diagnostic utility of genetic variants of fetal dextrocardia, accurately predict fetal prognosis, and guide perinatal management and the reproductive decisions of affected families.

Kefelegn Dejene Tadesse,1 Yidnekachew Asrat Birhan2 1Cardiology Department, Cardiac Center of Ethiopia, Addis Ababa, Ethiopia; 2Internal Medicine Department, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Kefelegn Dejene Tadesse, Email kefruit@gmail.comAbstract: Percutaneous transvenous mitral commissurotomy is an established treatment for rheumatic mitral stenosis. Dextrocardic heart can be affected by rheumatic pathology just like the normal heart. However, it is technically demanding to percutaneous interventions especially the septal puncture which should be done in a mirror image of the normal. Here we are reporting a 45 year old woman with severe rheumatic mitral stenosis with dextrocardia with situs inversus totalis. She has undergone a successful percutaneous transvenous mitral commissurotomy.Keywords: dextrocardia, mitral stenosis

The extracardiac Fontan procedure is the final common pathway for palliation of patients with univentricular physiology. The procedure is typically performed on cardiopulmonary bypass with or without fenestration using an adequate-sized polytetrafluoroethylene graft as the extracardiac conduit. On a few occasions, some patients may develop narrowing of their conduit with or without calcifications, which is often managed by various transcatheter techniques. Rarely, some of these conduits must be replaced surgically. In the current report, we present an alternative to standard surgical replacement of the calcified Fontan conduit in a patient with dextrocardia.

Congenitally corrected transposition of the great arteries (ccTGA) is a rare congenital anomaly defined by double discordance – atrioventricular and ventricular-arterial. ccTGA frequently has associated lesions, which influence long-term survival.

To evaluate the genetic etiology of fetal dextrocardia, associated ultrasound anomalies, and perinatal outcomes, we investigated the utility of whole exome sequencing (WES) for prenatal diagnosis of dextrocardia. Fetuses with dextrocardia were prospectively collected between January 2016 and December 2022. Trio-WES was performed on fetuses with dextrocardia, following normal karyotyping and/or chromosomal microarray analysis (CMA) results. A total of 29 fetuses with dextrocardia were collected, including 27 (93.1%) diagnosed with situs inversus totalis and 2 (6.9%) with situs inversus partialis. Cardiac malformations were present in nine cases, extra-cardiac anomalies were found in seven cases, and both cardiac and extra-cardiac malformations were identified in one case. The fetal karyotypes and CMA results of 29 cases were normal. Of the 29 cases with dextrocardia, 15 underwent WES, and the other 14 cases refused. Of the 15 cases that underwent WES, clinically relevant variants were identified in 5/15 (33.3%) cases, including the diagnostic variants DNAH5, DNAH11, LRRC56, PEX10, and ZIC3, which were verified by Sanger sequencing. Of the 10 cases with non-diagnostic results via WES, eight (80%) chose to continue the pregnancies. Of the 29 fetuses with dextrocardia, 10 were terminated during pregnancy, and 19 were live born. Fetal dextrocardia is often accompanied by cardiac and extra-cardiac anomalies, and fetal dextrocardia accompanied by situs inversus is associated with a high risk of primary ciliary dyskinesia. Trio-WES is recommended following normal karyotyping and CMA results because it can improve the diagnostic utility of genetic variants of fetal dextrocardia, accurately predict fetal prognosis, and guide perinatal management and the reproductive decisions of affected families. [ABSTRACT FROM AUTHOR]

Situs inversus totalis (SIT) with dextrocardia is a rare congenital anomaly that poses a surgical challenge. This case report presents the first known case of a totally 3D endoscopic mitral valve replacement (MVR), which was performed in a 75-year-old woman with SIT and severe functional mitral regurgitation. Despite the anatomical complexity, the procedure was successfully completed using a simplified three-port system and a 3D endoscope by requiring careful preoperative planning and intraoperative adaptation to the mirrored anatomy of SIT. This case report demonstrates the feasibility and potential benefits of totally endoscopic MVR in patients withSIT. [ABSTRACT FROM AUTHOR]

Dextrocardia with situs inversus are rare congenital anomalies which can be asymptomatic and compatible with normal life. They are characterized by mirror images of all intra-thoracic and intra-abdominal viscera. Our aim is to report an incidental finding of dextrocardia with situs inversus in a neonate with neonatal sepsis. A day-old male term neonate presented with features of infection. Physical examination revealed cardiac apex on the 4th right intercostal space, along the mid-clavicular line. Chest radiograph and abdominal ultrasound confirmed the diagnosis of dextrocardia with situs inversus. Bilateral cervical ribs were also seen on chest radiograph. He was managed with antibiotics and discharged. Newborn babies should have a thorough physical examination after delivery before discharge to enable early diagnosis of congenital anomalies for appropriate referral.

Dextrocardia with situs inversus totalis is a rare hereditary condition characterized by reversed orientation of the major thoracic and abdominal organs. Though dextrocardia itself is not believed to increase the risk of coronary artery disease, the workup and surgical management of patients with this condition may be technically challenging to heart team clinicians. This report describes the case management of a high-risk 56-year-old man with dextrocardia who presented with multivessel coronary artery disease.

Congenital birth defects of brachy/polysyndactyly class can occur as isolated defects or as a part of syndromes and should raise suspicion of associated heart defects. Poland syndrome is one such congenital condition with its characteristic features. Although rare, it can significantly impact a patient’s quality of life due to its physical and psychological effects. This case report aims to contribute to the limited body of literature by detailing the clinical presentation, diagnosis, and cardiac defects associated with Poland’s syndrome.

Respiratory distress in the newborn is associated with numerous etiologies, some common and some rare. When respiratory distress is accompanied by laterality defects, namely, situs inversus (SI), the index of suspicion for comorbid primary ciliary dyskinesia (PCD) should be raised. Primary ciliary dyskinesia is characterized by ciliary dysmotility and the accumulation of thick secretions in the airways that obstruct air and gas exchange. Neonatal clinicians should know that while PCD is definitively diagnosed in infancy or early childhood, findings suspicious for PCD should be communicated to primary care providers at discharge from the hospital to facilitate timely subspecialty involvement, diagnosis, and treatment. This article will present a case report of a term newborn with SI totalis who was later diagnosed with PCD. We will discuss epidemiology, pathophysiology, clinical manifestations, and diagnostics, followed by management strategies. Additionally, we discuss the outpatient needs and lifespan implications. [ABSTRACT FROM AUTHOR]

Situs inversus totalis (SIT) is a rare medical condition characterized by a complete mirror-image reversal of the normal positioning of the internal organs. Aristotle initially described situs inversus in animals, while Fabricius first characterized it in humans. Although the specific cause is uncertain, there is evidence of autosomal recessive and X-linked inheritance. Before seeking treatment for an unrelated ailment, many people with SIT are unaware of their distinct anatomy, as in our case. The presented case is a 30-year-old female patient from Central Ethiopia, presented to Hakim Gizaw Teaching Hospital outpatient department of medicine with the complaint of right-sided anterior chest pain for five days. Clinically, the apical beat was heard in the right 5th intercostal space. After undergoing an electrocardiogram (ECG), echocardiogram, chest X-ray, and abdominal ultrasound, she was diagnosed with situs inversus totalis. The clinical implications of SIT encompass challenges in diagnosis and procedures, potential congenital cardiac abnormalities, considerations for organ transplantation, and clinical decision-making, particularly in emergency scenarios. Key Clinical Messages. This case highlights the clinical implications of dextrocardia with situs inversus totalis, emphasizing the importance of awareness for accurate diagnosis, procedural challenges, and informed clinical decision-making. Understanding this rare condition is crucial for providing appropriate medical care and to navigate potential complications in affected individuals. [ABSTRACT FROM AUTHOR]

The extracardiac Fontan procedure is the final common pathway for palliation of patients with univentricular physiology. The procedure is typically performed on cardiopulmonary bypass with or without fenestration using an adequate-sized polytetrafluoroethylene graft as the extracardiac conduit. On a few occasions, some patients may develop narrowing of their conduit with or without calcifications, which is often managed by various transcatheter techniques. Rarely, some of these conduits must be replaced surgically. In the current report, we present an alternative to standard surgical replacement of the calcified Fontan conduit in a patient with dextrocardia. [ABSTRACT FROM AUTHOR]

Introduction: Patients with congenital heart disease are at increased risk for requiring cardiac pacing during their lifetime. Methods: We present the first described case of using two leadless pacing systems manufactured by separate companies implanted within the same patient to provide atrial and ventricular pacing due to complex congenital anatomy. Results: A 27‐year‐old male with dextrocardia with double outlet right ventricle, subaortic ventricular septal defect, and pulmonary stenosis status‐post pulmonary valve replacement complicated by ventricular pacing dependence and subsequent atrial pacing dependence after atriotomy‐based atypical flutter ablation developed recurrent mediastinitis and pocket infection with erosion despite prolonged antibiotic treatment. Due to atrial and ventricular pacing dependence, a comprehensive congenital care team concluded the need for lead extraction and replacement of pacemaker via leadless peacemaking device. Laser‐lead extraction and temporary atrial pacemaker placement was performed. Afterward, a transesophageal echocardiogram guided implantation of both a Micra AV 2 (Medtronic) leadless pacemaker in the interventricular septum within the right ventricle and an Aveir (Abbott) leadless pacemaker in the superior base of the right atrial appendage was performed with successful pacing. Although there is no communication between these devices, atrial‐mechanical ventricular pacing was reliable with good implant thresholds, impedances and sensing from both devices. Conclusion: Our case demonstrates the feasibility of using dual leadless pacing modalities to simultaneously pace someone at complex, prohibitive risk for temporary permanent or permanent pacemaker devices. [ABSTRACT FROM AUTHOR]

We present the case of a 74-year-old man with dextrocardia and situs inversus who presented with non-ST-elevation acute myocardial infarction. The patient underwent successful coronary angiography without requiring percutaneous coronary intervention or coronary artery bypass grafting. We discuss the patient’s clinical characteristics, electrocardiography findings, diagnosis, and treatment, and review the relevant literature.

Introduction: Dextrocardia is rare in the general population and may be associated with significant additional cardiac malformations. It is commonly associated with additional cardiac malformations. In this report, we have described the follow-up of a patient with Situs inversus dextrocardia and cyanogen complex cardiopathy in a 16-year-old Albanian male. The male patient born on 2007 in Albania, was referred to our ambulatory at 6 months of life by pediatrician cause of cyanosis and cardiac murmur. It was performed the echo Color Doppler examination, with the conclusion: situs inversus dextrocardia, unique ventricle, pulmonary arterial atresia. On 2008, a diagnostic catheterization was performed. The medico-chirurgical consultation has decided to leave the boy in natural history with a periodic follow–up. On 06.2009 in one of the routine examinations, there was make evidence of hypertrophy of the unique ventricle associated with arteria hypertension. From that time the patient is under medical treatment with periodic monitoring. Conclusions: The regular follow up of complex cyanogen congenital heart disease improve health care towards risqué target group. In heave desaturations patient the hypertension must be valuated as secondary complication of primary problem.

Abstract Background We aimed to identify the ideal chest compression site for cardiopulmonary resuscitation (CPR) in patients with a single ventricle with dextrocardia corrected by Fontan surgery. Methods The most recent stored chest computed tomography images of all patients with a single ventricle who underwent Fontan surgery were retrospectively analysed. We reported that the ideal chest compression site is the largest part of the compressed single ventricle. To identify the ideal chest compression site, we measured the distance from the midline of the sternum to the point of the maximum sagittal area of the single ventricle as a deviation and calculated the area fraction of the compressed structures. Results 58 patients (67.2% male) were analysed. The mean right deviation from the midline of the sternum to the ideal compression site was similar to the mean sternum width (32.85 ± 15.61 vs. 31.05 ± 6.75 mm). When chest compression was performed at the ideal site, the area fraction of the single ventricle significantly increased by 7%, which was greater than that of conventional compression (0.15 ± 0.10 vs. 0.22 ± 0.11, P

A letter published in the Archives of Gynecology & Obstetrics explores the potential association between COVID-19 infection and fetuses with mirror-image dextrocardia. The study conducted an epidemiological investigation to analyze the incidence of mirror-image dextrocardia in pregnant women and fetuses before and after the lifting of COVID-19 control measures in China. The findings suggest that there is a significant increase in the incidence of mirror-image dextrocardia in fetuses after the lifting of COVID-19 restrictions, with all pregnant women with this condition having a history of SARS-CoV-2 infection. The study proposes that maternal fever caused by the virus may interfere with the normal development of the embryonic heart. However, further research is needed to understand the specific mechanism. [Extracted from the article]

The article discusses a case of a 25-year-old primigravida with a fetus showing mirror-image dextrocardia and thoracic-abdominal discordance, detected through fetal echocardiography. Three-dimensional high-definition live tissue virtual dissection, including HD-live tissue rendering and 3D/4D spatiotemporal image correlation HD-live color rendering, was utilized to comprehensively analyze the complex cardiac morphology.

Background: We aimed to identify the ideal chest compression site for cardiopulmonary resuscitation (CPR) in patients with a single ventricle with dextrocardia corrected by Fontan surgery. Methods: The most recent stored chest computed tomography images of all patients with a single ventricle who underwent Fontan surgery were retrospectively analysed. We reported that the ideal chest compression site is the largest part of the compressed single ventricle. To identify the ideal chest compression site, we measured the distance from the midline of the sternum to the point of the maximum sagittal area of the single ventricle as a deviation and calculated the area fraction of the compressed structures. Results: 58 patients (67.2% male) were analysed. The mean right deviation from the midline of the sternum to the ideal compression site was similar to the mean sternum width (32.85 ± 15.61 vs. 31.05 ± 6.75 mm). When chest compression was performed at the ideal site, the area fraction of the single ventricle significantly increased by 7%, which was greater than that of conventional compression (0.15 ± 0.10 vs. 0.22 ± 0.11, P < 0.05). Conclusions: When performing CPR on a patient with Fontan circulation with dextrocardia, right-sided chest compression may be better than the conventional location. [ABSTRACT FROM AUTHOR]

Copyright of Alerta (San Salvador) - Revista Cientifica del Instituto Nacional de Salud is the property of Instituto Nacional de Salud and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Catheter ablation of atrial fibrillation (AF) has emerged as the most effective therapy. However, rare anatomical abnormalities such as situs inversus totalis, dextrocardia, or interrupted inferior vena cava can make ablation challenging. Methods and Results: We report a case of a 55‐year‐old woman with situs inversus totalis, dextrocardia, surgical atrial septal defect repair, left‐sided dual chamber pacemaker in place, and symptomatic recurrent persistent AF who underwent successful pulmonary vein and posterior wall isolation by the superior access from the left internal jugular vein. Conclusions: It is a feasible and safe approach with support of transesophageal echocardiography and multiple emerging technologies. [ABSTRACT FROM AUTHOR]

Mirror-image dextrocardia is a physiological variant in which the heart is located in a mirror position to the right of the position of the normal human heart. Mirror-image dextrocardia combined with acute large-artery occlusive stroke is extremely rare in clinical practice. We present here a 67-yearold woman with complete blockage in her left middle cerebral artery. The patient also had a mirrorimage dextrocardia. In this report, we share our experience in treating the patient using mechanical thrombectomy. During her visit to the emergency department, we performed various tests to understand the patient's anatomy. Based on the findings, we decided to approach the femoral artery. Using a combination of stent thrombectomy and intermediate catheter aspiration, we successfully restored blood flow to the patient's left middle cerebral artery. [ABSTRACT FROM AUTHOR]

Dextrocardia is a rare congenital malformation in humans in which most of the heart mass is positioned in the right hemithorax rather than on the left. The heart itself may be normal and dextrocardia is sometimes diagnosed during non‐related explorations. A few reports have documented atypical positions of the cardiac chambers in farmed teleost fish. Here, we report the casual finding of a left–right mirrored heart in an 85 cm long wild‐caught spiny dogfish (Squalus acanthias) with several organ malformations. Macroscopic observations showed an outflow tract originating from the left side of the ventricular mass, rather than from the right. Internal inspection revealed the expected structures and a looped cavity. The inner curvature of the loop comprised a large trabeculation, the bulboventricular fold, as expected. The junction between the sinus venosus and the atrium appeared normal, only mirrored. MRI data acquired at 0.7 mm isotropic resolution and subsequent 3D‐modeling revealed the atrioventricular canal was to the right of the bulboventricular fold, rather than on the left. Spurred by the finding of dextrocardia in the shark, we revisit our previously published material on farmed Adriatic sturgeon (Acipenser naccarii), a non‐teleost bony fish. We found several alevins with inverted (left‐loop) hearts, amounting to an approximate incidence of 1%–2%. Additionally, an adult sturgeon measuring 90 cm in length showed abnormal topology of the cardiac chambers, but normal position of the abdominal organs. In conclusion, left–right mirrored hearts, a setting that resembles human dextrocardia, can occur in both farmed and wild non‐teleost fish. [ABSTRACT FROM AUTHOR]

Key Clinical Message Situs inversus totalis is a rare diagnosis, but the likelihood of experiencing myocardial infarction is presumed to be comparable to the general population average. In individuals exhibiting situs inversus with suspected myocardial infarction, ECG recording, including right precordial leads, is crucial for diagnostic assessment. Coronary angiography and intervention should be performed with standard equipment using inverted maneuvers and radiographic projections.

We report a successful percutaneous mitral balloon commissurotomy via left transhepatic venous access in a 42-year-old female patient with dextrocardia, situs inversus totalis, and inferior vena cava interruption. fWe also discuss the revisions required for optimal trans-septal approach from the left transhepatic vein.

Background: Kartagener's syndrome, a rare autosomal recessive genetic disorder, is characterized by primary ciliary dyskinesia (PCD), resulting in defective cilia function in the respiratory tract and fallopian tubes. Case presentation: This case report discusses a 23-year-old female with Kartagener's syndrome, bronchiectasis, and cardiac involvement, who presented with shortness of breath, cough, and syncope. Notably, she received home oxygen therapy but became exhausted, leading to loss of consciousness. Clinical examination revealed prominent heart sounds and abnormal lung findings. Laboratory results indicated leukocytosis, and an ECG confirmed dextrocardia and cardiac abnormalities. Doppler studies identified mitral and tricuspid regurgitation along with severe pulmonary arterial hypertension. Antibiotics were administered for coagulase-negative Staphylococcus infection. The patient improved with a treatment regimen, including oxygenation and nebulization. Regular follow-up and patient education were emphasized. Conclusion: This case underscores the complexity of Kartagener's syndrome and the importance of a multidisciplinary approach in managing its respiratory and cardiac manifestations. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Situs inversus totalis is a rare diagnosis, but the likelihood of experiencing myocardial infarction is presumed to be comparable to the general population average. In individuals exhibiting situs inversus with suspected myocardial infarction, ECG recording, including right precordial leads, is crucial for diagnostic assessment. Coronary angiography and intervention should be performed with standard equipment using inverted maneuvers and radiographic projections. [ABSTRACT FROM AUTHOR]

Situs inversus totalis (SIT) is a congenital condition in which the major visceral organs are reversed or in a mirror image from their normal positions that affects one per 10,000 live births. It is associated with dextrocardia (DXC) in which the heart is located on the right side of the chest. We present a challenging cardiac resynchronization therapy (CRT) implantation in a 60‐year‐old man with SIT‐DXC, heart failure, extreme bradycardia, wide QRS, and left ventricular (LV) dysfunction. The procedure was complex due to the mirror‐image anatomy and the tortuous origin of the coronary sinus (CS) branches that required a subselection catheter for adequate lead implantation. [ABSTRACT FROM AUTHOR]

We present a rare case of tetralogy of Fallot accompanied with dextrocardia, situs inversus and anomalous origin of the right coronary artery. Total repair was accomplished successfully using a minimally invasive left axillary thoracotomy. [ABSTRACT FROM AUTHOR]

Background: Mirror dextrocardia (MDC) is a condition in which the heart is located in a mirror-image position on the right side of the chest compared to the normal position in individuals with physiological variations. Patients with MDC and chronic total occlusion (CTO) of the left circumflex branch (LCX) are extremely rare in clinical practice. The treatment of MDC-CTO-LCX differs significantly from patients without mirror dextrocardia and the same condition in terms of instrument selection and procedural techniques. In this article, we report a successful case of interventional treatment in a patient with MDC-CTO-LCX. We summarize the anatomical and electrocardiographic variations in patients with MDC-CTO-LCX, and discuss the selection of interventional instruments and techniques that can be useful for interventionists as well as the diagnostic and therapeutic considerations that can be helpful for clinical physicians. Case presentation: A male Han Chinese patient, 51, was admitted, presenting recurrent chest pain for a year and recent onset of exertional fatigue over the past week.He reported episodes of chest pain following physical activities over the past year, lasting between 5 and 20 min.Despite these symptoms, the patient did not seek immediate medical attention, and the occurrence of his chest pain has progressively lessened within the year.A week prior, the patient developed exertional dyspnea after brief walks, though without any episodes of nocturnal paroxysmal dyspnea.Upon arrival at our hospital for evaluation, he was initially diagnosed with chronic coronary syndrome, previous inferior myocardial infarction, atrial arrhythmia, and classified under the New York Heart Association functional class III.Following his admission, a chest X-ray and coronary angiography were conducted.The results indicated mirror dextrocardia and total occlusion of the left circumflex branch. Percutaneous coronary intervention (PCI) was performed on the left circumflex branch. Subsequent angiography demonstrated optimal stent positioning without evidence of hematoma or dissection.Following the procedure, the patient's symptoms of chest pain and exertional dyspnea were resolved, which led to his subsequent discharge.A follow-up electrocardiogram, 10 months post-procedure, displayed a slow and regular atrial rhythm. Conclusions: The incidence of dextrocardia is very low, and it may appear normal on an electrocardiogram; however, careful diagnosis is required when there is an abnormal direction of the P wave in limb leads. During the operation for chronic occlusive lesions of the right-sided coronary artery, the anomalous anatomical structure necessitates specific requirements for instrument selection and operative techniques. After revascularization of chronic occlusive vessels in dextrocardia, routine electrocardiographic examination may show false normalization, requiring caution in interpretation. [ABSTRACT FROM AUTHOR]

Patients with dextrocardia and d-transposition of the great arteries (d-TGA) present a technical challenge when performing the arterial switch operation (ASO). We sought to determine the long-term outcomes of this rare presentation. All patients who underwent the ASO with d-TGA and dextrocardia were identified from the hospital database. There were four patients with dextrocardia (4 of 844, 0.5%) patients; two patients had situs solitus and two patients had situs inversus. Three patients had a ventricular septal defect. Left ventricular outflow tract obstruction was present in one patient and one patient had a hypoplastic arch with severe coarctation of aorta. Anomalous coronary anatomy occurred in two patients. There was one early mortality and the cause of death was sepsis. One patient required late reoperation for severe neo-pulmonary valve regurgitation at 23 years after the ASO. At last follow-up, all three surviving patients were in New York Heart Association Class I. Patients with d-TGA and dextrocardia who undergo the ASO are extremely rare and require challenging operative management. [ABSTRACT FROM AUTHOR]

Background Percutaneous closure is nowadays still deemed challenging in patent forame ovale (PFO) associated to multi-fenestrated atrial septal aneurysm (ASA). This anatomic arrangement is still considered a significant risk factor for recurrence of paradoxical embolism. Theoretically, transcatheter approach could be theoretically even more complex in the case of dextrocardia and visceral situs inversus. Case summary A 59-year-old man with history of migraine with aura and multiple cryptogenic strokes was referred for percutaneous closure of a PFO with associated ASA. He had been previously submitted to repeat attempt of percutaneous closure with not self-centering and self-centering devices that failed due to unfavorable anatomic characteristics (dextrocardia with situs viscerum inversus, huge ASA, multiple fenestrations, large PFO). Based on this "complex" anatomy, a sequential 2-step interventional approach aiming to reduce size and mobility of the atrial septal aneurysm with a suture-based approach (Noblestich™ EL, HeartStitch, Fountain Valley, CA, USA) and to close any eventual accessory fenestrations with a not self-centering occluding device was planned. At the end of the procedure, the ASA completely disappeared and no residual shunt was imaged at TEE bubble test. Discussion We describe a very rare case of symptomatic ASA-PFO in dextrocardia with situs viscerum inversus as well as an innovative approach to treat such complex anatomic setting by using the suture-based closure of a PFO to reduce size and mobility of an ASA in order to deploy dedicated not-self-centering occluding devices. [ABSTRACT FROM AUTHOR]

Although dextrocardia is a rare congenital anomaly, it may be accompanied by numerous pathologies. Tricuspid valve prolapse is an extremely uncommon cause of primary tricuspid valve disease, as is its association with dextrocardia. In this instance, we wished to share our knowledge of tricuspid commissural prolapse together with dextrocardia, which we augmented with 3D images. [ABSTRACT FROM AUTHOR]