Presentation
Interrupted feeding, sweating on feeding, constipation, and limited weight gain. No cyanosis or fever.
Patient Data
Cardiomegaly. Dextrocardia with situs inversus (right sided gastric air bubble and left sided liver shadow).
Status post cardiac surgery. Sternotomy sutures are intact. Enteric tube, bilateral thoracic drains and epicardial pacing wire are seen in pace.
Interval removal of bilateral thoracic drains. Rest of the findings are same as seen on the previous study.
Case Discussion
Preoperative workup (echocardiogram and cardiac CT scan) showed: left isomerism, mirror image dextrocardia, L-looped heart, normal systemic and pulmonary venous connection, superior vena cava duplication and interrupted inferior vena cava (with azygos continuation of IVC to the right-sided SVC, draining to the coronary sinus and then to the left-sided atrium and left-sided SVC and the pulmonary veins connected to the left-sided atrium). Ventriculo-arterial concordance with mirror image positioning of great arteries (aorta posterior and left to the anterior and right main pulmonary artery), moderate to large size perimembranous ventricular septal defect (VSD) with a left to right shunt.
The patient underwent surgery (VSD repair with Gore-Tex patch). Two JP drains were inserted into the right pleural space and mediastinum and one bipolar pacing wire was attached to the right ventricle.