Dextrocardia With Situs Solitus

This represents an anomaly with normal situs but a right-sided heart. Radiographically, normal situs (situs solitus) is a certainty when both the aortic knob and the gastric air bubble are on the left side. Situs soJitus also means that both the abdominal viscera and the atria are in the normal position. Under these circumstances, if the ventricles fail to swing from the primitive right-sided position to the normal left-sided position, abnormal relationships between the ventricles and the rest of the cardiovascular structures are bound to develop. This entity was formerly termed dextroversion.

In patients with dextroversion, the incidence of congenital heart disease has been estimated at 98 percent. More than 80 percent have congenitally corrected (or L-loop) transposition of great arteries. The next most commonly associated lesions are a combination of ventricular septal defect and pulmonary stenosis, a tetralogy-like pathophysiology (Fig. 12-12). Therefore, from a statistical point of view, it is important to be able to differentiate this entity from dextrocardia with situs inversus, which is associated with a much lower incidence of congenital heart disease (see above and also Chap. 63).

Air Bubbles Coronary Artery

Figure 12-12: Posteroanterior view of a patient with dextrocardia and situs solitus. Note that the aortic arch and the stomach air bubble are both on the left (situs soJitus) and the apex of the ventricles is pointing to the right inferiorly. According to statistics and proved by cardiac catheterization, this patient had the typical

Figure 12-12: Posteroanterior view of a patient with dextrocardia and situs solitus. Note that the aortic arch and the stomach air bubble are both on the left (situs soJitus) and the apex of the ventricles is pointing to the right inferiorly. According to statistics and proved by cardiac catheterization, this patient had the typical combination of congenitally corrected transposition of the great arteries, ventricular septal defect, and pulmonary stenosis. He was cyanotic. The pulmonary vascularity appears decreased.

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