KeyWords

Situs Inversus; Mesocardia; Congenitally Corrected TGA.

Introduction

Situs Inversus is a condition which affects all major structures within the thorax and abdomen. Generally, the organs are simply transposed through the sagittal plane. If the heart is shifted to the right side of the thorax along with mirror imaging of intra abdominal organs, it is known as situs inversus totalis (1 in 10,000 of the general population) and the associated anatomical and functional defects are less. If the heart remains on the normal left side of the thorax, a much rarer condition (1 in 22,000), it is known as situs inversus incompletes, and there will be multiple cardiac defects associated with this condition. The chromosomal or embryological defect that causes Situs inversus is not know but it is considered as an autosomal recessive genetic condition, which can be X-linked.

Case Report

A four year old male child born out of a non consanguineous marriage was admitted for evaluation of recurrent episodes of respiratory infections and dyspnea on exertion. Child was a known case of congenital heart disease diagnosed in the first month of life and no further follow up study was done. There was no history of cyanosis or pedal edema. No history of developmental delay and child was immunized up to the age. On admission the patient had upper respiratory infection, stable vital signs. On cardiovascular system examination apex beat palpated on 5th intercostal space 1cm medial to left midclavicular line. Pansystolic murmur heard on tricuspid area and ejection systolic murmur heard on aortic and mitral areas. On abdominal examination abnormal liver dullness and Traubs space dullness was found and child was evaluated with abdominal ultrasonography, which showed intra-abdominal mirror imaging of all the solid organs and vessels. This finding was followed by chest X-ray which showed centrally placed heart and prominent pulmonary artery and infiltrates. ECG showed sinus tachycardia with right axis deviation and abnormal wave pattern in all leads. Clinically child became stable in two days and echocardiography was done for the child who showed Mesocardia with congenitally corrected transposition of great arteries, bidirectional VSD and severe valvular pulmonary stenosis. Child was discharged with oral digoxin and potassium supplementation. Patents were advised to have monthly follow up and corrective surgery for the child.

Complete Blood Count

Total Count : 15870 cells/cu mm
Neutrophil : 40 %
Lymphocyte : 52 %
Monocytes : 05 %
Eosinophils : 03 %
Haemoglobin :13.6 gms%, PCV : 40.9 % MCV-74fl,MCH -24.7 Pg, MCHC- 33.3%
Platelet Count : 3.39 lakhs /cu mm

Echocardiography and Colour Doppler Report

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Fig1:

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Echocardiography and Colour Doppler Report.

Abdoinal Ultrasonography Report

Situs Inversus Totalis
No abnormalities detected in abdominal organs

Electro Cardiography Report

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Fig2:

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Electro Cardiography Report.

Conclusion

It is an extremely rare condition to have Mesocardia in a patient with Situs Inversus. This case gives an account that mesocardia can present with multiple cardiac defects similar to situs inversus incompletes.

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