Systematization and clinical study of dextroversion, mirror-image dextrocardia, and laevoversion

Off-pump coronary artery bypass grafting in patients with mirror-imaging dextrocardia

Dextrocardia requires alterations in techniques during coronary artery bypass graft (CABG) surgery. We report two cases undergoing off-pump coronary artery bypass graft (OPCAB) surgery and discuss techniques for the operative management of these patients.

Situs inversus with dextrocardia in a mummy case

A mummy of a young woman, who died due to tuberculous peritonitis and salpingitis, is conserved in the Pathological Anatomy Museum of the University of Padua. It was found at autopsy to have situs inversus of viscera with dextrocardia, apparently in the absence of other congenital defects. A 64-section scanner computed tomography (CT) on the specimen was carried out to investigate the internal condition of organs. The CT revealed the presence in the heart of a muscular ventricular septal defect and of calcific deposits on visceral pericardium and aortic wall, in keeping with sequelae of previous tuberculous pericarditis.

Diagnosis and outcome of dextrocardia diagnosed in the fetus

A retrospective review of 5,539 fetal echocardiograms over a 22-year period revealed 85 cases of dextrocardia. In primary dextrocardia (46 cases), the incidence of situs solitus, inversus, and ambiguous, was similar and associated with a high incidence of complex cardiac malformations in situs solitus and situs ambiguous. Secondary dextrocardia (39 cases) was due to intrathoracic displacement and, when caused by diaphragmatic hernia, was associated with cardiac malformations in 31% of cases. Even in complex cases, fetal echocardiography was highly accurate; therefore, specific counseling can be given to parents.

Aortic atresia with visceral situs inversus with mirror-image dextrocardia

A newborn infant with situs inversus totalis (visceral situs inversus with mirror-image dextrocardia) with aortic atresia is presented. No reports of this anatomical variant have previously been reported in the literature. A brief discussion of the various types of congenital heart defects and their incidence in association with situs inversus totalis is presented.

Morphological considerations pertaining to recognition of atrial isomerism. Consequences for sequential chamber localisation

The atrial morphology and venous connections were assessed "blind" in 51 necropsy specimens from patients with visceral heterotaxy. This was compared with bronchial morphology as established by dissection. Six specimens were found to have both atria and bronchi in situs solitus or inversus, and were rejected. In the remainder, atrial isomerism was diagnosed, though this required minor revision of the atrial assessment in two patients. Thirty-four patients had isomeric right atria and bronchi, while 11 had isomeric left atria and bronchi. In seven cases, splenic status was unknown, but in seven of the remaining 38 (18.4%) atrial isomerism was not associated with either asplenia or polysplenia. Nevertheless, right isomerism was strongly associated with total anomalous pulmonary venous drainage (as is asplenia) and left isomerism was likewise associated with interruption of the inferior vena cava (as is polysplenia). Bilateral superior venae cavae and hepatic veins, and absence of the coronary sinus, were frequent in both forms of isomerism (as they are in asplenia and polysplenia). These findings suggest that atrial situs can be defined as solitus inversus, right isomerism, and left isomerism. This determination of atrial situs is quite independent of any other abnormalities of visceral situs. The high incidence of anomalies of both venous return and common atrium resulted in presumed complete mixing of blood at atrial level in all but one patient (97.8%), making the haemodynamic connection between atria and ventricles almost always ambiguous. To describe this anatomical connection as ambiguous when there are two ventricles present is therefore no more than recognition of anatomical and haemodynamic reality.