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Levocardia

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Last Updated: 04 December 2020

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Levocardia

SpecialtyCardiology

Axial and cranial views of the fetus by ultrasound and magnetic resonance imaging at 35 weeks of gestation at the level of heart and stomach. Panels C and F are schematic presentations of B and F, respectively. The Axis of heart suggest levocardia. SP, spine. Direction of cardiac axis is shown clearer than on ultrasound. The stomach is show on the right side of the abdomen. The stomach is detected as a high intensity area in fetal MRI. R? L indicate right and leave sides, respectively; A? P indicate anterior and posterior directions of the fetus, respectively.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

DISCUSSION

The position or location of organs and vessels is usually classified into three types; situs solitus, situs inversus, and situs ambiguous. Situs solitus is usual arrangement of organs and vessels within the body. Only 0. 6-0. 8% of patients with situs solitus and levocardia have associated congenital heart diseases. Situs inversus refers to anatomic arrangement that is a mirror image of situs solitus. The incidence of congenital heart disease increased to 3-5% in patients with situs inversus. Situs ambiguous, or heterotaxy, is defined as visceral malposition and dysmorphism, which is different from orderly arrangement seen in situs solitus or situs inversus. This syndrome has a variety of conditions, including left isomerism and right isomerism. Patients with heterotaxy have congenital heart disease in high incidence, ranging from 50 to nearly 100%. The IL condition was first described by Taussig, as situs inversus with levocardia. The word isolate levocardia was first defined by Liberthson et al. As condition in which the heart is normally place in the thoracic cavity, but the abdominal viscera is situated in situs inversus or heterotaxy. IL cases have often been reported in children and adults, and are diagnosed incidentally or due to associated cardiac malformations. In contrast, only a few reports have been published concerning prenatal diagnosis of IL.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

INTRODUCTION

Isolated levocardia is situs anomaly, characterized by leftsided heart associated with visceral heterotaxy. According to published reports, its estimated incidence is 1 per 22 000 births in the general population and between 0. 4 and 1. 2% in all patients with congenital heart disease. Prognosis depends on the severity of associated cardiac anomaly, and only 5-13% of IL patients have been reported to surviving for longer than 5 years. IL has also been found unexpectedly in surgical cases, for instance, bowel obstruction or volvulus, which were caused by visceral heterotaxy. However, most IL patients without cardiac anomaly or intestinal complications are likely to survive unnoticed. As a result, precise prenatal incidence of IL is difficult to estimate. At present, owing to progress in fetal imaging techniques, IL can be diagnosed before birth. Because treatment is required immediately after birth in some cases, prenatal diagnosis should be made precisely. However, most of reported cases were diagnosed in childhood or even in adulthood, and only five cases of prenatal IL have been reported to date. Here we present two cases of IL diagnosed prenatally and discuss issues concerning prenatal diagnosis and management of IL.


CASE REPORT

A 30-year-old woman presented a history of palpitation. Examination reveal acyanotic patient with situs inversus and pansystolic and mid diastolic murmur best heard in the right lower parasternal area. An Electrocardiogram, chest X-ray, and echo doppler study were done Echocardiogram reveal situs inversus, levocardia, atrio-ventricular, and ventriculo-arterial discordance. There was continuity between the pulmonary valve and leave AV valve. There was thickening and doming of tricuspid valve and commissures were fuse. Valve movement was restricted to moderate stenosis and moderate regurgitation. In addition, mild aortic valve regurgitation was also see. In retrospect, patient was interrogated for a history of rheumatic fever. She gave history of an episode of polyarthritis with fever at the age of 15 years, but was not investigated because of lack of facilities. Thus, diagnosis of situs inversus with levocardia with correct transposition with rheumatic stenosis and regurgitation of tricuspid valve was make.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Methods and Results

A number of classification schemes have been proposed to characterize and categorize various congenital cardiac malformations. 18-24 one known as segmental approach To diagnosis of CHD assumes sequential, systematic analysis of three major cardiac segments to characterize abnormalities in give patient. The guiding principle of this approach is that specific cardiac chambers and vascular structures have characteristic morphologic properties that determine their identities, rather than their positions within the body. 25 organize, systematic identification of all cardiac structures or segments and their relationships to each other is carried out to define give patient's anatomy. 26 initial steps To characterize anomalies and classify child's cardiovascular disease are to determine cardiac position within thorax and Situs of thoracic and abdominal organs. The position of the heart can be described in terms of its location within the thoracic cavity and direction of the cardiac apex. For simplicity, following approach is frequently used The term levocardia indicates that the heart is in the left hemithorax, as is normally the case. Dextrocardia specifies that the heart is located in the right hemithorax and mesocardia that heart is displaced rightward but not completely in the right thoracic cavity. It is important to consider that abnormal location of the heart within the thorax may result from displacement of the heart by adjacent structures or underlying noncardiac malformations. Visceral Situs or sidedness of abdominal organs and atrial Situs are considered independently. Visceral Situs is classified as solitus, inversus, or ambiguous. Abnormal arrangements or sidedness of abdominal viscera, heart, and lungs suggest a high likelihood of complex cardiovascular pathology. Atrial Situs, atrioventricular connections, ventricular looping, ventriculoarterial connections, and relationship between great vessels are then delineate. Finally, any associated malformations are describe, including the number and size of septal defects if present, valvar and / or great vessel abnormalities, and so on. Whereas many types of congenital defects fall neatly into this classification scheme, others, such as Heterotaxy syndromes, are often more difficult to precisely define. Segmental, sequential approach is the essence of diagnostic assessment in CHD. 9-11 It assumes stepwise, systematic examination of all cardiac structures or segments and their relationships by navigating through the heart in the direction of blood flow. The principle of this scheme is that specific cardiac chambers and vascular structures have characteristic morphologic properties that determine their identities, rather than their positions within the body. 12 approach starts by determining cardiac position within thorax, direction of cardiac apex, and arrangement or Situs of thoracic and abdominal organs. Cardiac position can be described as the spatial location of the majority of cardiac mass within the thorax, using sternum as midline reference. Cardiac orientation refers to alignment from base to apex.


Case 1

A 34yearold woman was referred to our unit for evaluation of dextrogastria detected during a routine scan at 23 weeks' gestation. Sonography confirm dextrogastria with levocardia, and the gallbladder was located at midline. Hyperechogenicity posterior to stomach was interpreted as spleen. There were normal connections between pulmonary and hepatic veins to the fetal heart. Intrahepatic IVC was not identify, and azygous continuation to SVC was visualize. The female fetus was delivered with a birth weight of 3885 g and Apgar scores of 9 and 10 at 1 and 5 minutes. Abdominal sonography revealed transverse liver and 2 spleens on the right side and confirmed interruption of IVC with azygous continuation. Findings from chest radiography and echocardiography were normal. After longterm followup of 2 years, child was healthy and developing well.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

POSITION OF THE HEART

In adult two-Dimensional transthoracic echocardiographic examination, standard series of cross-sectional anatomical views are recommended by the American Society of Echocardiography. 1-6 Each echocardiographic view is described using three aspects of examination, namely transducer position at specified anatomical window on or near thorax, Cardiac scan plane transect by transducer beam, and anatomical structure or region of interest. The 1-12 2D TTE examination is the basis for comprehensive assessment of Cardiac structure and function. 2D TTE examination supplants M-Mode examinationa one-Dimensional motion-Mode examination, which remains useful adjunct to 2D TTE protocol. 2D TTE examination is also complemented by additional Echocardiography protocols. These include Doppler Echocardiography and Three-Dimensional Echocardiography. 13-18 Myocardial segmentation nomenclature and assessment is integral to 2D TTE examination. 19 bony chest wall and air-fill lungs are major obstacles to transmission of ultrasound beam. Consequently, optimal examination of an adult heart requires placing ultrasound transducer at specified positions or windows on or near the chest wall. Four primary transducer positions or windows are recommend. For patients with normal levocardia, examination begins at Left parasternal windowP, followed by Apical windowA, Subcostal or subxiphoid windowSC, and suprasternal notch windowSSN. 1-6 by convention, tomographic imaging of most human organs and structures are described according to anatomical Position and standard anatomical planesmedian, transverse, and frontal. Thanks to its Embryology, heart is unique in its disregard for this cardinal principle. 5-7 Three orthogonal imaging planes are used as reference for each standard echocardiographic view: long-axisLAX, short-axisSAX, and Four-chamber4C planes. 1 45 Cardiac LAX plane lies parallel to the Left Ventricular long-Axis, transect LV apex, center of aortic valve, and anteroposterior diameter of the mitral valve. LAX planes of LV can be acquired from both leave parasternal and Apical windows. 1-6 Cardiac SAX plane transect Heart orthogonal to LV long Axis, starting from the Cardiac baseat aortic valve level, then slicing toward LV apex. SAX planes of LV can be acquired from both leave parasternal and Subcostal windows. 1-6 Cardiac 4C plane transects Both atria, Both ventricles, and their intervening septae. This 4C plane is orient orthogonal to both Cardiac LAX and SAX planes. 4C planes of Heart can be acquired from both Apical and Subcostal windows. The 1-6 third component used to describe each standard echocardiographic view is structure or region of interest.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Sources

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

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