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3.
Tex Heart Inst J ; 51(1)2024 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-38623731

RESUMO

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.


Assuntos
Doença da Artéria Coronariana , Dextrocardia , Situs Inversus , Masculino , Humanos , Pessoa de Meia-Idade , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/cirurgia , Situs Inversus/complicações , Situs Inversus/diagnóstico , Situs Inversus/cirurgia , Dextrocardia/complicações , Dextrocardia/cirurgia , Ponte de Artéria Coronária , Doenças Raras
5.
Am J Case Rep ; 25: e942006, 2024 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-38451882

RESUMO

BACKGROUND Duplication of the gastrointestinal tract is a rare congenital malformation that can develop in any part of the digestive tract. These duplications may be asymptomatic into adult age. Situs inversus totalis is a rare congenital anomaly characterized by a mirror transposition of thoracic and abdominal organs. We present a case of a pancreatic pseudocyst in a patient with a combination of situs inversus totalis and doubling of the esophagus, stomach, and first part of the duodenum. CASE REPORT A 64-year-old woman presented with epigastric pain. Abdominal computed tomography revealed a pancreatic pseudocyst and a previously identified duplication of the esophagus, stomach, and duodenum with situs inversus totalis. The patient underwent esophagogastroduodenoscopy (EGD) with endoscopic ultrasonography for pseudocyst drainage. During EGD, a bifurcation of the esophagus was found. Duplication of the esophagus, stomach, and first part of the duodenum was evident on further advancement. A week later, there was repeated filling of the pseudocyst with a liquid component, and the patient underwent cystogastrostomy with stenting. Five months after discharge, the stent was removed without complications. CONCLUSIONS Duplication of the gastrointestinal tract and situs inversus totalis are very rare congenital malformations that require early diagnosis. While situs inversus totalis does not represent any medical disadvantage, physicians should be aware of abnormal anatomy before procedures to prepare specialists for this in case of the need for special techniques. Endoscopic treatment of pancreatic pseudocysts is safe and effective even in such rare cases. The use of endoscopic methods also minimizes intervention and decreases the length of the patients' stays in the hospital.


Assuntos
Dextrocardia , Pseudocisto Pancreático , Situs Inversus , Feminino , Humanos , Pessoa de Meia-Idade , Abdome , Dextrocardia/complicações , Pseudocisto Pancreático/diagnóstico por imagem , Pseudocisto Pancreático/cirurgia , Pseudocisto Pancreático/complicações , Situs Inversus/complicações , Situs Inversus/diagnóstico , Tomografia Computadorizada por Raios X
6.
Medicine (Baltimore) ; 103(13): e37625, 2024 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-38552073

RESUMO

RATIONALE: Situs inversus totalis is a rare malposition of organs that typically involves lesions in the respiratory, circulatory, or urinary systems. Cases of congenital hemivertebrae combined with situs inversus totalis are extremely rare and have limited reports. PATIENT CONCERNS: We report a 2.5 years old girl with 2 congenital hemipyramids and complete visceral inversion who ultimately underwent hemilaminectomy. DIAGNOSIS: Congenital hemivertebrae combined with situs inversus totalis. INTERVENTION: The patient underwent hemilaminectomy. OUTCOMES: The spinal deformity was corrected. LESSONS: For patient with spinal deformities combined with situs inversus totalis, surgery can be an effective treatment method. But we also need to be vigilant about the dysfunction of various systems.


Assuntos
Dextrocardia , Anormalidades Musculoesqueléticas , Situs Inversus , Feminino , Humanos , Pré-Escolar , Dextrocardia/complicações , Dextrocardia/diagnóstico por imagem , Dextrocardia/cirurgia , Situs Inversus/complicações , Situs Inversus/diagnóstico por imagem , Anormalidades Musculoesqueléticas/cirurgia , Laminectomia , Resultado do Tratamento
7.
Medicine (Baltimore) ; 103(8): e37093, 2024 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-38394506

RESUMO

BACKGROUND: Situs inversus is a rare congenital anatomical variant that involves a group of anomalies regarding the arrangement of intrathoracic and intraabdominal organs. Being able to find in the abdominal region the liver, gallbladder, inferior vena cava, and head of the pancreas and ascending colon on the left side of the abdomen, while on the right side there is the spleen, the stomach, the body of the pancreas, the ligament of Treitz, descending colon among others. In this same way, the thoracic organs, lungs and heart, are changed in their position in a mirror translocation. METHODS: We systematically searched MEDLINE, Web of Science, Google Scholar, CINAHL, Scopus, and LILACS; the search strategy included a combination of the following terms: "Situs inversus," "Situs inversus totalis," "Cancer," "Neoplasm," "Abdominopelvic regions," and "clinical anatomy." RESULTS: Within the 41 included studies, 46 patients with situs inversus who had cancer, in addition to being found in this organ and in these regions, we also found as a result that the majority of the studies in the research were in stage II; finally, no one study could assert the direct relationship between the situs inversus totalis and the cancer. CONCLUSION: If our hallmarks could make us think that more exhaustive follow-up of the stomach and other organs should be carried out in these patients, there could also be other predisposing factors for cancer, which is why more studies are suggested to give future diagnostic and treatment guidelines treatment.


Assuntos
Dextrocardia , Neoplasias , Situs Inversus , Humanos , Situs Inversus/complicações , Situs Inversus/diagnóstico , Abdome/anormalidades , Baço/anormalidades
8.
Catheter Cardiovasc Interv ; 103(4): 565-569, 2024 03.
Artigo em Inglês | MEDLINE | ID: mdl-38344889

RESUMO

Coronary angioplasty in patients with a right-sided heart may be difficult due to challenges in engaging the coronary arteries, interpreting angiogram, and further delivering intracoronary therapies. We present our experience of percutaneous coronary intervention in two cases and propose a practical algorithm to approach cardiac catheterization in these patients.


Assuntos
Angioplastia Coronária com Balão , Dextrocardia , Intervenção Coronária Percutânea , Humanos , Resultado do Tratamento , Intervenção Coronária Percutânea/efeitos adversos , Angiografia Coronária
9.
Am J Case Rep ; 25: e942323, 2024 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-38409778

RESUMO

BACKGROUND Situs inversus totalis (SIT) is a rare congenital abnormality that includes mirror-image transposition of both the abdominal and the thoracic organs. It may remain undetected into adulthood until an acute medical emergency results in diagnostic imaging. This report presents a challenging case of left-sided acute appendicitis in a 45-year-old man with SIT. CASE REPORT A 45-year-old man with a medical history of gastroesophageal reflux disease, class 2 obesity, prediabetes, and elevated low-density lipoprotein cholesterol presented with severe acute abdominal pain localized in the left lower quadrant with localized tenderness, nausea, and 2 episodes of non-bloody and non-bilious emesis that started a day before the clinical encounter. Computed tomography of the abdomen and pelvis revealed previously undiagnosed congenital SIT. In addition, physical, laboratory, and radiological findings suggested early acute appendicitis with no evidence of complications. Hence, the patient was managed with an emergent laparoscopic appendectomy. Acute appendicitis was confirmed in the post-surgery histopathological examination. The post-surgery recovery was uneventful, and the patient was discharged home on the second postoperative day. CONCLUSIONS This report highlights that SIT may remain undiagnosed into adulthood and poses a challenge in the diagnosis of left-side appendicitis due to atypical symptom presentation, supporting the findings of previous case reports. Therefore, the inclusion of left-sided acute appendicitis in the differential diagnosis of abdominal pain in the left lower quadrant is warranted.


Assuntos
Apendicite , Dextrocardia , Laparoscopia , Situs Inversus , Masculino , Humanos , Pessoa de Meia-Idade , Apendicectomia/efeitos adversos , Apendicite/complicações , Apendicite/diagnóstico , Apendicite/cirurgia , Dextrocardia/complicações , Situs Inversus/diagnóstico , Dor Abdominal/etiologia , Dor Abdominal/cirurgia , Doença Aguda , Laparoscopia/métodos
10.
Echocardiography ; 41(2): e15788, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38400626

RESUMO

Three-dimensional virtual dissection using high-definition live tissue rendering ultrasound tool of a 23-week gestation fetus with situs solitus, mirror image dextrocardia, ventricular septal defect, aortic override, and pulmonary atresia.


Assuntos
Dextrocardia , Cardiopatias Congênitas , Comunicação Interventricular , Humanos , Dextrocardia/complicações , Dextrocardia/diagnóstico por imagem , Aorta/anormalidades , Feto
11.
J Cardiovasc Electrophysiol ; 35(3): 418-421, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38213071

RESUMO

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.


Assuntos
Dextrocardia , Dupla Via de Saída do Ventrículo Direito , Marca-Passo Artificial , Masculino , Humanos , Adulto , Estimulação Cardíaca Artificial/efeitos adversos , Ventrículos do Coração , Dupla Via de Saída do Ventrículo Direito/etiologia , Resultado do Tratamento , Marca-Passo Artificial/efeitos adversos , Desenho de Equipamento
13.
BMC Cardiovasc Disord ; 24(1): 22, 2024 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-38172727

RESUMO

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.


Assuntos
Reanimação Cardiopulmonar , Dextrocardia , Técnica de Fontan , Humanos , Masculino , Feminino , Reanimação Cardiopulmonar/efeitos adversos , Técnica de Fontan/efeitos adversos , Estudos Retrospectivos , Esterno , Dextrocardia/diagnóstico por imagem
16.
Am J Cardiol ; 211: 137-140, 2024 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-37918473

RESUMO

We present the case of a patient with known situs inversus referred for cardiac catheterization, which revealed a chronic total occlusion of the right coronary artery. Situs inversus, a rare congenital abnormality, is a term used to describe the inverted position of the chest and abdominal organs. Cardiac catheterization is rare in patients with this particular abnormality. It is important to customize techniques to engage coronary arteries and optimize guide support if percutaneous coronary intervention is required in these particular cases.


Assuntos
Dextrocardia , Situs Inversus , Doenças Vasculares , Humanos , Angiografia Coronária , Dextrocardia/complicações , Situs Inversus/complicações , Angioplastia
17.
Medicine (Baltimore) ; 102(48): e36295, 2023 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-38050294

RESUMO

RATIONALE: Using an electronic visualized double-lumen endobronchial tube (E-visual DLT) allows for excellent surgical visualization during one-lung ventilation. Situs inversus totalis (SIT) is a rare autosomal recessive genetic condition wherein the bronchial and pulmonary lobar structures on the left and right sides of individuals are reversed compared to those of the general population. In the case of SIT, placing a left-sided E-visual DLT into the right bronchus might offer more advantageous one-lung ventilation. However, there have been no reported instances of using E-visual DLT single-lung ventilation anesthesia techniques for SIT. PATIENTS CONCERNS: We present a case report detailing the effective implementation of a visualized single-lung ventilation technique under general anesthesia in a 36-year-old male diagnosed with SIT. The patient had a mediastinal mass and underwent thoracoscopic resection of the mediastinal mass using a left-sided approach. DIAGNOSES: Based on the findings from the contrast-enhanced chest computed tomography (CT) results, the patient was diagnosed with SIT along with a mediastinal mass. Surgical intervention was proposed to alleviate the cardiac compression caused by the mass. Nevertheless, the administration and handling of anesthesia posed a notable challenge since clinical anesthesiologists encounter contradictory data and a limited number of evidence-based guidelines. INTERVENTIONS: Convened a multidisciplinary meeting prior to the initiation of anesthesia to formulate a comprehensive strategy. Throughout the anesthetic management, our team ensured meticulous monitoring, delivered sufficient oxygenation, and established hemodynamic equilibrium. The anesthesia team deliberated and devised a plan to employ a left-sided E-visual DLT placement through the right bronchus for right-sided one-lung ventilation in the patient with SIT. The process of anesthesia induction was subjected to repeated simulations to guarantee patient safety. OUTCOMES: Due to the meticulous and effective administration and supervision of anesthesia, the surgery was completed as planned. Subsequently, the removal of the E-visual DLT was executed without any complications. LESSONS: Data and literature about SIT are scarce, necessitating thorough pre-planning and preparation.


Assuntos
Dextrocardia , Situs Inversus , Masculino , Humanos , Adulto , Intubação Intratraqueal/métodos , Brônquios , Pulmão , Anestesia Geral , Situs Inversus/complicações
18.
J Cardiovasc Electrophysiol ; 34(12): 2621-2625, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37987539

RESUMO

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.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Dextrocardia , Cardiopatias Congênitas , Situs Inversus , Feminino , Humanos , Pessoa de Meia-Idade , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/diagnóstico por imagem , Situs Inversus/complicações , Situs Inversus/diagnóstico por imagem , Situs Inversus/cirurgia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia , Dextrocardia/complicações , Dextrocardia/diagnóstico por imagem , Cardiopatias Congênitas/cirurgia
19.
J Med Case Rep ; 17(1): 486, 2023 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-37990278

RESUMO

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.


Assuntos
Fibrilação Atrial , Oclusão Coronária , Dextrocardia , Intervenção Coronária Percutânea , Humanos , Masculino , Dor no Peito/etiologia , Doença Crônica , Angiografia Coronária , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/cirurgia , Dextrocardia/complicações , Dextrocardia/diagnóstico por imagem , Dextrocardia/cirurgia , Dispneia , Intervenção Coronária Percutânea/métodos , Resultado do Tratamento , Pessoa de Meia-Idade
20.
J Int Med Res ; 51(10): 3000605231208594, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37903317

RESUMO

Colon cancer in patients with situs inversus totalis is rarely associated with dextrocardia, and chemotherapy is commonly used for treatment. Central venous access devices are used to administer intravenous fluids and chemotherapy in patients with colon cancer. Compared with peripherally inserted central catheters and Hickman-type tunneled catheters, totally implantable vascular access devices (TIVADs) are safer and more effective. However, positioning the catheter tip may be challenging in patients with dextrocardia and situs inversus. We herein describe a novel case involving a patient with dextrocardia and colon cancer who was treated by TIVAD insertion with intracavitary electrocardiography-aided tip localization.


Assuntos
Cateteres Venosos Centrais , Neoplasias do Colo , Dextrocardia , Situs Inversus , Humanos , Cateteres de Demora/efeitos adversos , Dextrocardia/complicações , Dextrocardia/diagnóstico por imagem , Situs Inversus/complicações , Neoplasias do Colo/complicações , Neoplasias do Colo/tratamento farmacológico
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