Subpulmonary Obstruction Due to Aneurysmal Ventricular Septum in a Patient with Congenitally Corrected Transposition of the Great Arteries and Dextrocardia

Abstract

Congenitally corrected Transposition of Great Arteries is usually associated with multiple cardiac defects. Morphologic left-ventricular outflow (pulmonary) tract obstruction due to aneurysm of the membranous ventricular septum in patients with corrected transposition and ventricular septal defect is rare, but was reported in the past. This is even more uncommon in patients with dextrocardia, prompting us to document this case. Absence of the conus with resultant proximity of the aneurysm to the subpulmonary region and higher pressures in the left-sided morphologic right ventricle lead to obstruction of outflow tract in corrected transposition. Echocardiogram with Doppler interrogation and cardiac catheterization with selective cineangiography are the diagnostic tests of choice. Surgical resection of the aneurysm with patch closure of ventricular septal defect, avoiding injury to the conduction system, is recommended.University Heart Journal Vol. 10, No. 1, January 2014; 31-38

Situs Inversus Totalis: A Rare Congenital Anomaly and the Presence of COPD Giving a Concept of Dextroposition with Limb Lead Reversal in ECG

“…Unfortunately, there is no registry in Bangladesh. Only few cases were reported 3,4,5,6 . This positional anomaly is important for a physician as -1) to prevent a surgical disaster in diagnosis and/ or surgical intervention following failure to identify the reversed anatomy or an atypical history as cholecystitis causes left upper quadrant pain 2) for the prevention of false-negative reporting by the radiologist resulting from inattention to labelling or false-labelling by a technician 3) to avoid misleading electrocardiographic findings 4) to evaluate all cardiac structure in an organized way as a small proportion have some form of congenital heart disease 5) to identify another disease 'kartagener syndrome' having bronchiectasis, sinusitis and situs invertus.…”

“…It shows inverted P, QRS and T wave in lead I & aVL, positive deflection in aVR with decreasing amplitude of R wave from lead V 1 through V 6 . A same feature is seen in case of reversal of the arm leads except decreasing R wave amplitude in V 1 -V 6 .…”