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Mirror-image dextrocardia: why is the apex impulse not on the right?

Spiegelbildliche Dextrokardie: warum ist der Herzspitzenstoß nicht rechts?

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Abstract

This article presents the case of an 11-year-old girl with a history of Fortan surgery who presented to the authors’ department with shortness of breath, orthopnea, and cyanosis. Electrocardiography (ECG) was indicative of mirror-image dextrocardia despite location of the apex impulse on the left. Echocardiography suggested mirror-image dextrocardia accompanied by levoversion, a large atrial septal defect and left ventricular atresia (functional single atrium and single ventricle), and right ventricular hypertrophy. ECG with corrected leads placement showed a sinus rhythm, biatrail enlargement, and right ventricular hypertrophy. Based on echocardiography and medical history, the case was rediagnosed as mirror-image dextrocardia with levoversion.

Zusammenfassung

Im vorliegenden Beitrag wird der Fall eines 11-jährigen Mädchens mit Fontan-Operation in der Anamnese beschrieben, das sich mit Kurzatmigkeit, Orthopnoe und Zyanose in der Klinik der Autoren vorstellte. Das Elektrokardiogramm (EKG) ergab Hinweise auf eine spiegelbildliche Dextrokardie trotz Lokalisation des Herzspitzenstoßes auf der linken Seite. In der Echokardiographie zeigte sich eine spiegelbildliche Dextrokardie mit begleitender Lävoversion, einem großen Vorhofseptumdefekt und linksventrikulärer Atresie (funktioneller einzelner Vorhof und einzelner Ventrikel) sowie rechtsventrikulärer Hypertrophie. Das EKG mit korrigierter Platzierung der Elektroden zeigte einen Sinusrhythmus, Hinweise auf eine biatriale Vergrößerung und eine rechtsventrikuläre Hypertrophie. Auf Grundlage der Echokardiographie und der Anamnese wurde in diesem Fall die Diagnose geändert zu spiegelbildlicher Dextrokardie mit Lävoversion.

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Funding

Information: Scientific Research Project (“Seedling breeding” project for young scientific and technological talents) from Education Department of Liaoning Province (number: JYTQN201926).

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Authors and Affiliations

  1. Electrocardial Center, First Affiliated Hospital, Jinzhou Medical University, Jinzhou, China

    Ye Liu

  2. Department of Endocrine and Metabolic Diseases, First Affiliated Hospital, Jinzhou Medical University, Jinzhou, China

    Bing Song

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  1. Ye Liu
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  2. Bing Song
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Corresponding author

Correspondence to Bing Song.

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Conflict of interest

Y. Liu and B. Song declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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Liu, Y., Song, B. Mirror-image dextrocardia: why is the apex impulse not on the right?. Herz 46, 381–384 (2021). https://doi.org/10.1007/s00059-020-04971-7

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  • DOI: https://doi.org/10.1007/s00059-020-04971-7

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