PMC5308496_01
Posteroanterior chest radiograph demonstrates a left heart axis, right-sided gastric bubble.
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Chest X-ray showed a left heart axis, a right-sided gastric bubble below the right diaphragm and left-sided hepatic contour (Figure 1).
Preoperative cardiac catheterization of a CCTGA and Situs Inversus patient showed the anteriorly placed aorta arising from the morphologic right ventricle and the posteriorly placed pulmonary artery arising from the morphologic left ventricle and in association with ventricular septal defect (long arrow), pulmonary stenosis (short arrow). AO=Aort, P=Pulmonary artery, mRV= morphologic right ventricle.
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Contrast filled the mRV and flowed right to left across the VSD and filled the pulmonary trunk (Figure 2).
Transesophageal echocardiography (TEE). A- four-chamber view showed discordance atrioventricular connection and morphologic Left atrium in the right side is connected to the morphologic right ventricle, Morphologic right atrium in the left side is connected to the morphologic left ventricle, LV= left atrium, RA= right atrium, RV= right ventricle, B- VSD (arrow), C- The aorta arises in anterior and the right side of the pulmonary trunk. A= aort, D- Liver (narrow) is on the left, revealing Situs Inversus.
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Transesophageal echocardiogram (TEE) confirmed the diagnosis, and showed situs inversus, levocardia, AV and ventriculoarterial discordance, and also revealed that the aorta was on the right side, anteriorly located, u and furthermore a sub aortic VSD and severe PS (Figure 3) was also seen.
Placing an external valved conduit from morphologic left ventricle to pulmonary trunk.
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The process was completed by inserting an external biological valved 25mm conduit from the morphologic left ventricle (mLV) to the pulmonary trunk (Figure 4).