While the heart shadow may not give it away at once, note the unusual position of the pacemaker electrodes.

Not only that the patient has situs inversus, this is also a diagnosed case of levo-transposition of the great arteries with an ostium secundum atrial septal defect, large membranous ventricular septal defect and pulmonary (valve) stenosis. He previously underwent Blalock-Taussig shunt procedure, closure of the septal defects and correction of the pulmonary stenosis.