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LETTER TO EDITOR
Year : 2016  |  Volume : 26  |  Issue : 1  |  Page : 25-26

Echocardiographic diagnosis of isolated levocardia with D-transposition of great arteries


Department of Cardiology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India

Date of Web Publication10-Mar-2016

Correspondence Address:
Ramachandra Barik
Department of Cardiology, Nizam's Institute of Medical Sciences, Hyderabad - 500 082, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2211-4122.178470

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How to cite this article:
Barik R. Echocardiographic diagnosis of isolated levocardia with D-transposition of great arteries. J Cardiovasc Echography 2016;26:25-6

How to cite this URL:
Barik R. Echocardiographic diagnosis of isolated levocardia with D-transposition of great arteries. J Cardiovasc Echography [serial online] 2016 [cited 2018 Nov 14];26:25-6. Available from: http://www.jcecho.org/text.asp?2016/26/1/25/178470

Dear Sir,

A 20-year-old male presented with features of right heart failure. There was no cyanosis or clubbing. He was a known case of chronic kidney disease on regular hemodialysis. The height of jugular venous pulse pressure in sitting position was 9 cm with prominent “a” and blunt Y descent. X-ray of chest and abdomen was consistent with situs inversus levocardia (SIL). A detailed sequential segmental analysis was done using two-dimensional echocardiograghy. The presence of significant pericardial effusion supported better echo windows. In the subxiphoid view, the inversion of abdominal viscera was confirmed [Figure 1]. Transthoracic echo in apical 4-chamber view [Figure 2]a and [Video 1] demonstrated levocardia, D-loop ventricle, atrial inversion and SIL with D-transposition great arteries [Figure 2]b and [Video 2]. There were large remote ventricular septal defect (VSD) and a large secundum atrial septal defect. Right ventricular systolic pressure was 124 mmHg which was his right arm systolic blood pressure in the sitting position. Tricuspid annular plane systolic excursion was of 0.9 cm. Aortic arch was on the left side. A complete echo diagnosis was complex congenital heart disease, SIL, D-loop ventricle (isolated levocardia), D-transposition of great arteries (DTGA), both atrial and ventricular septal defects (VSDs), increasing pulmonary blood flow situation, significant right heart (systemic ventricle) failure, moderated pericardial but without evidence of thrombus or vegetation. This is the second case vignette, wherein a complete diagnosis of isolated levocardia with DTGA has been documented only by echocardiographic sequential segmental analysis.[1],[2] [Figure 3]a and [Figure 3]b shows in sketches of normal four-chamber view and a four chamber view of isolated levocardia using transthoracicecho forcomparison.
Figure 1: Subxiphoid view of two-dimensional echo shows minor lobe of liver on the right side and major lobe of liver on the left side. AO: Aorta, IVC: Inferior vena cava

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Figure 2: (a) Transthoracic echo in apical 4-chamber view shows inverted atria (right atrium and left atrium), normal position of tricuspid valve, mitral valve, right ventricle, and left ventricle. (b) D-transposition of great arteries

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Figure 3: (a) A rough sketch of transthoracic echo illustrates normal atrial situs and D-loop ventricles. The words written in red and blue letters indicate the saturated and desaturated blood respectfully. (b) A rough sketch of inversion of atrial situs

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  References Top

1.
Anderson RH, Shirali G. Sequential segmental analysis. Ann Pediatr Cardiol 2009;2:24-35.  Back to cited text no. 1
    
2.
Chang HY, Yin WH, Hsiung MC, Young MS. A heart reversed triply: Situs inversus totalis with congenitally corrected transposition of the great arteries in a middle-aged woman. Echocardiography 2009;26:617-21.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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