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Rao PS. Therapy of Patients with Cardiac Malposition. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040739. [PMID: 37189988 DOI: 10.3390/children10040739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 03/31/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023]
Abstract
Positional abnormalities per se do not require treatment, but in their place, the accompanying pulmonary pathology in dextroposition patients and pathophysiologic hemodynamic abnormalities resulting from multiple defects in patients with cardiac malposition should be the focus of treatment. At the time of the first presentation, treating the pathophysiologic aberrations caused by the defect complex, whether it is by improving the pulmonary blood flow or restricting it, is the first step. Some patients with simpler or single defects are amenable to surgical or transcatheter therapy and should be treated accordingly. Other associated defects should also be treated appropriately. Biventricular or univentricular repair dependent on the patient's cardiac structure should be planned. Complications in-between Fontan stages and after conclusion of Fontan surgery may occur and should be promptly diagnosed and addressed accordingly. Several other cardiac abnormalities unrelated to the initially identified heart defects may manifest in adulthood, and they should also be treated.
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Affiliation(s)
- P Syamasundar Rao
- Children's Heart Institute, Children's Memorial Hermann Hospital, McGovern Medical School, University of Texas-Houston, 6410 Fannin Street, UTPB Suite # 425, Houston, TX 77030, USA
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Wiedmann F, De Simone R, Rose P, Karck M, Gorenflo M, Frey N, Schmidt C. Case report of an S-ICD implantation for secondary prevention in a patient with complex congenital heart disease, dextrocardia, and situs solitus. Eur Heart J Case Rep 2022; 6:ytac253. [PMID: 35821967 PMCID: PMC9269672 DOI: 10.1093/ehjcr/ytac253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/17/2022] [Accepted: 06/22/2022] [Indexed: 11/12/2022]
Abstract
Abstract
Background
Dextrocardia is a congenital anomaly in which the apex of the heart is abnormally located on the right side of the chest. Situs solitus describes viscera that are in the normal position, with the stomach on the left side. In these patients, implantation of transvenous implantable cardioverter-defibrillator (ICD) can be limited by anatomical abnormalities commonly associated with this condition.
Case summary
We present the case of a young female patient with absent right atrioventricular connection, morphologically left systemic ventricle, muscular restrictive ventricular septal defect, and dextrocardia with situs solitus who was indicated for secondary prophylactic ICD implantation after resuscitation for polymorphic ventricular tachycardia. Due to a bilateral bidirectional Glenn anastomosis, transvenous access via the vena cava superior to the right ventricle could not be achieved. For this reason, we successfully implanted a subcutaneous ICD (S-ICD) with an individually optimized right parasternal electrode position. Potential complications of epimyocardial implantation via re-thoracotomy could thus be circumvented.
Discussion
In patients with complex congenital heart disease, the S-ICD is an effective method of preventing sudden cardiac death. Our case report demonstrates the feasibility of left S-ICD implantation even in the presence of dextrocardia with situs solitus.
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Affiliation(s)
- Felix Wiedmann
- Department of Cardiology, University Hospital Heidelberg , Heidelberg , Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, University of Heidelberg , Heidelberg , Germany
- HCR, Heidelberg Centre for Heart Rhythm Disorders, University Hospital Heidelberg , Heidelberg , Germany
| | - Raffaele De Simone
- Department of Cardiac Surgery, University Hospital Heidelberg , Heidelberg , Germany
| | - Peter Rose
- Department of Cardiac Surgery, University Hospital Heidelberg , Heidelberg , Germany
| | - Matthias Karck
- Department of Cardiac Surgery, University Hospital Heidelberg , Heidelberg , Germany
| | - Matthias Gorenflo
- Department of Pediatric Cardiology and Congenital Heart Diseases, University Hospital Heidelberg , Heidelberg , Germany
| | - Norbert Frey
- Department of Cardiology, University Hospital Heidelberg , Heidelberg , Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, University of Heidelberg , Heidelberg , Germany
- HCR, Heidelberg Centre for Heart Rhythm Disorders, University Hospital Heidelberg , Heidelberg , Germany
| | - Constanze Schmidt
- Department of Cardiology, University Hospital Heidelberg , Heidelberg , Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, University of Heidelberg , Heidelberg , Germany
- HCR, Heidelberg Centre for Heart Rhythm Disorders, University Hospital Heidelberg , Heidelberg , Germany
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Xu J, Jiang G, Zhang L, Chen Z, Wang H, Bai M, Zeng J. Successful percutaneous left atrial appendage occlusion for atrial fibrillation in a patient with mirror-image dextrocardia: a case report. BMC Cardiovasc Disord 2022; 22:20. [PMID: 35090397 PMCID: PMC8800237 DOI: 10.1186/s12872-021-02369-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/03/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Dextrocardia is a rare congenital condition (1/10,000-12,000) and AF is uncommon (1-2%). Therefore, the occurrence of the two conditions is rare. Percutaneous left atrial appendage occlusion (LAAO) is a treatment to prevent atrial fibrillation (AF)-associated thromboembolic events. CASE PRESENTATION An 85-year-old female with known situs inversus totalis, persistent AF, and stroke was treated with oral anticoagulation, but she was suffering from constant gingival bleeding. Her CHA2DS2VASc score was 6 points (abnormal, ≥ 2), and her HAS-BLED score was 4 points (abnormal, ≥ 3). The transthoracic echocardiography (TTE) demonstrated left atrial (LA) enlargement (46 mm) and 50% of ejection fraction. She underwent percutaneous LAAO for stroke recurrence prevention using a Watchman occluder. The operation was successful but with technical differences compared with a standard case because of the dextrocardia. CONCLUSION This is the first reported case of a percutaneous LAAO in situs inversus dextrocardia. This case indicates the feasibility of LAAO in congenital cardiac malposition combined with AF.
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Affiliation(s)
- Jizhe Xu
- Heart Center, Gansu Heart Center, Key Laboratory for Cardiovascular Disease of Gansu, The First Hospital of Lanzhou University, Lanzhou, China
| | - Gaxue Jiang
- Heart Center, Gansu Heart Center, Key Laboratory for Cardiovascular Disease of Gansu, The First Hospital of Lanzhou University, Lanzhou, China
| | - Lu Zhang
- Heart Center, Gansu Heart Center, Key Laboratory for Cardiovascular Disease of Gansu, The First Hospital of Lanzhou University, Lanzhou, China
| | - Zixian Chen
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Hao Wang
- Department of Anesthesiology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Ming Bai
- Heart Center, Gansu Heart Center, Key Laboratory for Cardiovascular Disease of Gansu, The First Hospital of Lanzhou University, Lanzhou, China.
| | - Jie Zeng
- Department of Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
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