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      Coronary Artery Bypass Grafting in a Patient with Dextrocardia with Situs Inversus

      case-report

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          Abstract

          Dextrocardia involves embryologic malformations leading to a right hemithorax heart with rightward apex. Situs inversus encompasses all viscera in mirrored position. A 76-year-old male with dextrocardia with situs inversus presented for coronary artery bypass grafting due to a non-ST elevation myocardial infarction. Management was altered accordingly. Electrocardiography leads and defibrillator pads were reversed. A left internal jugular vein central venous catheter provided direct access to the right atrium. Transesophageal echocardiography confirmation of aortic and venous cannulation required turning the probe right for the right-sided aorta and left for liver visualization, respectively. Proactive surgical and anesthetic management was imperative for the successful and uneventful outcome for this patient.

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          Task force 1: the changing profile of congenital heart disease in adult life.

          Carole Warnes, Richard R. Liberthson, Gordon Danielson … (2001)
          Article 0 comments Cited 230 times – based on 0 reviews     Review now
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            A population-based study of cardiac malformations and outcomes associated with dextrocardia.

            Claudine M Bohun, James E. Potts, Brett Casey … (2007)
            The incidence of dextrocardia and its associated cardiac and noncardiac malformations is not known. There is inadequate information about outcomes to counsel parents about prognosis. A retrospective review of all diagnoses of dextrocardia due to embryologic development at a tertiary care hospital from 1985 to 2001 was performed. Eighty-one cases were identified (48 antenatally). The incidence of dextrocardia was estimated to be 1 in 12,019 pregnancies. Twenty-seven cases were situs solitus, 30 situs inversus, and 24 situs ambiguous or isomerism. Cardiac malformations were found in 26 of 27 cases of situs solitus, 7 of 30 cases of situs inversus, and 24 of 24 cases of isomerism. Noncardiac malformations were identified in 10 of 27 cases of situs solitus, 6 of 30 cases of situs inversus, and 14 of 24 cases of isomerism. Twelve pregnancies were terminated, 3 fetuses were stillborn, and 2 women chose compassionate care. All terminated fetuses were diagnosed with dextrocardia before termination, and all had >1 cardiac anomaly; 7 also had noncardiac anomalies. There were 43 subjects in the intention-to-treat group (20 situs solitus, 10 solitus inversus, 13 isomerism). Thirty-two had >or=1 cardiac operation, and 21 had >or=3. Thirty-nine subjects were alive at most recent follow-up. In conclusion, the incidence of dextrocardia was 1 in 12,019 pregnancies. In conclusion, in our cohort, the numbers of cases of situs solitus, situs inversus, and isomerism were similar. Cardiac and noncardiac malformations were most common in the isomerism group. Cardiac malformations were often complex in the situs solitus and isomerism groups. Ninety-one percent of those in the intention-to-treat cohort were alive at follow-up.
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              Adult presentation of heterotaxic syndromes and related complexes.

              Helen T Winer-Muram (1994)
              (Definitions) Situs solitus indicates the normal position of the cardiac atria and viscera. Situs solitus with levocardia is the normal situation, with < 1% incidence of congenital heart disease (Table 1). Levocardia denotes a left-sided heart and a left cardiac apex; it does not give any indication of cardiac structure or body situs (Fig. 1A). Situs inversus is the mirror-image location of the atria and abdominal viscera (Fig. 1B). Heterotaxia is the abnormal arrangement of organs and major blood vessels different from the orderly arrangement of either situs solitus or situs inversus. In situs ambiguus or heterotaxia, the relationship of the atria and viscera is inconsistent. Isomerism, a form of heterotaxia, is a term used to describe symmetric morphology, i.e., both sides of the viscera, and both lungs are nearly identical to one another (Fig. 2). Right isomerism or asplenia syndrome is characterized by situs ambiguus with bilateral right-sidedness (Fig. 2A). Left isomerism or polysplenia syndrome is a second type of situs ambiguus characterized by bilateral left-sidedness (Fig. 2B). In this review, all patients having situs ambiguus with either right isomerism (asplenia syndrome) or left isomerism (polysplenia syndrome) are regarded as having cardiac malposition, an inappropriate cardiac position.
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                Author and article information

                Contributors
                Kaitlin E. Woods:
                ORCID: https://orcid.org/0000-0001-5829-2294
                Journal
                Journal ID (nlm-ta): Case Rep Anesthesiol
                Journal ID (iso-abbrev): Case Rep Anesthesiol
                Journal ID (publisher-id): CRIA
                Title: Case Reports in Anesthesiology
                Publisher: Hindawi
                ISSN (Print): 2090-6382
                ISSN (Electronic): 2090-6390
                Publication date Collection: 2020
                Publication date (Electronic): 14 December 2020
                Volume: 2020
                Electronic Location Identifier: 8885881
                Affiliations
                1Department of Medical Education, West Virginia University, Morgantown, WV, USA
                2Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV, USA
                3Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology, West Virginia University, Morgantown, WV, USA
                Author notes

                Academic Editor: Anjan Trikha

                Author information
                https://orcid.org/0000-0001-5829-2294
                Article
                DOI: 10.1155/2020/8885881
                PMC ID: 7752276
                SO-VID: 29341432-802c-4281-9141-53c63259d663
                Copyright © Copyright © 2020 Kaitlin E. Woods et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 19 June 2020
                Date accepted : 1 December 2020
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Anesthesiology & Pain management
                Data availability:
                ScienceOpen disciplines: Anesthesiology & Pain management

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