Female ; Heart Septal Defects, Atrial ; complications ; Humans ; Levocardia ; complications ; Situs Inversus ; complications ; Young Adult

Situs inversus of the abdominal organs in the presence of normally placed heart on the left side of the thorax is known as situs inversus with isolated levocardia. This rare condition is commonly associated with severe congenital defects of the heart. We report a case of situs inversus with levocardia in a 19-year-old asymptomatic male patient with completely normal heart on the left chest. Spiral computed tomography of the thorax and abdomen and echocardiographic studies revealed situs inversus of abdominal organs, normal heart (levocardia), mirrored left lungs, a midline liver, a left-sided inferior vena cava connecting to the right atrium, multiple splenic masses in the abdominal right upper quadrant, and aneurysmal dilatation of a splenic artery.
Abdomen ; Aneurysm ; Congenital Abnormalities ; Dilatation ; Heart ; Heart Atria ; Heterotaxy Syndrome* ; Humans ; Levocardia* ; Liver ; Lung ; Male ; Situs Inversus ; Splenic Artery ; Thorax ; Tomography, Spiral Computed ; Vena Cava, Inferior ; Young Adult

Levocardia (left-sided cardiac apex) with abdominal situs inversus is extremely rare. This is also known as isolated levocardia and is almost always associated with severe forms of congenital heart defects with poor prognosis. We report isolated levocardia in a 13-year-old symptomatic male patient. The purpose of this paper is to outline the imaging features of isolated levocardia and to highlight the role of cardiovascular magnetic resonance imaging (CMR) in the diagnosis and management of such cases. Other forms of cardiac malposition, including dextrocardia, mesocardia and criss-cross heart, with chest radiograph and CMR correlation, are also discussed.
Abnormalities, Multiple ; diagnosis ; Adolescent ; Diagnostic Imaging ; Humans ; Levocardia ; diagnosis ; Magnetic Resonance Imaging, Cine ; Male ; Radiography, Thoracic ; Situs Inversus ; diagnosis ; Tomography, X-Ray Computed

The corrected transposition of the great arteries is an usual congenital cardiac malformation, which consisitsof transposition of great arteries and ventricular inversion, and which is caused by abnormal developement ofconotruncus and ventricular looping. High frequency of associated cardiac malformations makes it difficult to getaccurate morphologic diagnosis. A total of 18 cases of corrected transposition of the great arteries is presented,in which cardiac catheterization and angiocardiography were done at the Department of Radiology, Seoul NationalUniversity Hospital between Sep. 1976 and June 1981. The clinical, radiogrpahic ,and operative findings with theemphasis on the angiocardiographic findings were analized. The resuls are as follows; 1. Among 18 cases, 13 caseshave normal cardiac position, 2 cases have dextrocardia with situs solitus, 2 cases have dextrocardia with situsinversus and 1 case has levocardia with situs inversus. 2. Segmental sets are {S.L.L.} in 15 cases, and {I.D.D} in3 cases and there is no exception to loop rule. 3. Side by side interrelationships of both ventricles and bothsemilunar valves are noticed in 10 and 12 cases respectively. 4. Subaortic type conus is noted in all 18 cases. 5.Associated cardiac malformations are VSD in 14 cases, PS in 11, PDA in 3, PFO in 3, ASD in 2, right aortic arch in2, tricuspid insufficiency, mitral prolapse, persistent left SVC and persistent right SVC in 1 case respectively.6. For accurate diagnosis of corrected TGA, selective biventriculography using biplane cineradiography is anessential procedure.
Angiocardiography ; Aorta, Thoracic ; Arteries ; Cardiac Catheterization ; Cardiac Catheters ; Cineradiography ; Conus Snail ; Dextrocardia ; Diagnosis ; Levocardia ; Mitral Valve Insufficiency ; Prolapse ; Seoul ; Situs Inversus ; Transposition of Great Vessels

Abnormalities, Multiple ; surgery ; Adult ; Ductus Arteriosus, Patent ; surgery ; Heart Defects, Congenital ; surgery ; Heart Septal Defects, Ventricular ; surgery ; Humans ; Levocardia ; surgery ; Male ; Vena Cava, Inferior ; abnormalities

We report a case of common bile duct (CBD) cancer, successfully managed with pancreaticoduodenectomy, in a patient with isolated levocardia, malrotation, and situs ambiguous (without splenic anomalies). A 59-year-old male patient was referred to Chung-Ang University Hospital with epigastric pain and jaundice. CT and MRI revealed distal CBD cancer without significant lymphadenopathy. Multiple abdominal anatomic anomalies were identified preoperatively, whereas no anatomic anomalies were detected within the chest. The patient had a right-sided stomach and spleen, liver at the midline, several vascular variations around the celiac axis, and intestinal malrotation, but the inferior vena cava and portal vein were normal. A pancreaticoduodenectomy was performed to treat the cancer. The postoperative course was favorable, and the patient was started on combined chemotherapy and radiotherapy 15 days after the surgery. In this case study, we report that pylorus preserving pancreaticoduodenectomy was successful for distal CBD cancer in a patient with rare situs anomalies.
Axis, Cervical Vertebra ; Common Bile Duct ; Drug Therapy ; Humans ; Jaundice ; Levocardia* ; Liver ; Lymphatic Diseases ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pancreaticoduodenectomy* ; Portal Vein ; Pylorus ; Radiotherapy ; Spleen* ; Stomach ; Thorax ; Vena Cava, Inferior

Double-outlet right ventricle is defined as follows: both great arteries arise completely or nearly completelyfrom the right ventricle; neither semilunar valve is in fibrous continuity with either atrioventricular valve; andusually a ventricular septal defect is present and the only outlet from the left ventricle. A total of 44 cases ofdouble-outlet right ventricle is analyzed, in which cineangiocardiographies were done at the Department ofRadiology, Seoul National University Hospital in recent 4 year and 6 months, with specific reference to thesegmental combinations, the height of conus the relationship of great arteries, the location of ventricular septaldefects, and associated anomalies. The resuslts were as follows; 1. Among 44 cases, 36 cases had normal cardiacposition, 4 cases had dextrocardia with situs inversus, 2 cases had dextrocardia with situs solitus, 1 case hadlevocardia with situs inversus, and another 1 case had mesocardia with situs ambiguus. 2. Segmental sets were[S.D.D] in 36 cases, [I.L.L] in 3 cases, [I.D.D] in 2 cases, [S.D.L], [S.L.L] and [A,D,D] in 1 case respectively.3. All cases had bilateral conus. Aortic valve rings were same level as pulmonary valve rings in 25 cases, lowerthan pulmonary valve rings in 17 cases in which 15 cases were type A., and higher than pulmonary valve rings in 2cases. 4. The relation of the great arteries were normal in 15 cases, side-by side in 13 cases, dextromalpositionin 13 cases, and levomal position in 3 cases. 5, The position of the ventricular septal defects with respect tothe origins of the great arteries is subaortic (type A & type B) in 23 cases, subpulmonary (type C) in 13 cases,double committed (type D) in 3 cases, and uncommitted (type E) in 5 cases. 6. Associated cardiac malformations arepulmonary stenosis in 24 which had all cases of type A and type E, aortic stenosis in 6 which were only in type C,left SVC in 6, abnormality of atrioventricular valve in 5, single coronary artery in 4, interrupted IVC in 1,obstructive VSD in 2, ASD in 4, PDA in 4, right aortic arch with levocardia in 5, and ectopic spleen withmesocardia in 1 case. 7. Biplane cinecardioangiogram must be performed in both ventricles to define the VSD andits relationship to the great arteries, and, if necessary, should also be performed in the aorta to rule outcoarctation and coronary artery abnormalities, and in the pulmonary artery to visiualize pulmonary venous returnand mitral valve. Angiography is of crucial importance in differentiating double-outlet right ventricle fromtetralogy of Fallot and complete transposition of the great arteries.
Angiography ; Aorta ; Aorta, Thoracic ; Aortic Valve ; Aortic Valve Stenosis ; Arteries ; Constriction, Pathologic ; Conus Snail ; Coronary Vessels ; Dextrocardia ; Double Outlet Right Ventricle ; Heart Septal Defects, Ventricular ; Heart Ventricles ; Heterotaxy Syndrome ; Levocardia ; Mitral Valve ; Pulmonary Artery ; Pulmonary Valve ; Seoul ; Situs Inversus ; Spleen