Dextrocardia and ventricular septal defect with situs inversus: Anesthetic implications and management

Abstract

The patients with complicated congenital heart diseases are reaching adulthood with advances in corrective surgeries and medical management. Impact of anesthetic agents on complex cardiac and extra cardiac anomalies and presence of previous palliative procedures can be a challenge for the anesthesiologist perioperatively, while these patients present for cardiac/noncardiac surgeries. We report the perioperative management of a patient with ventricular septal defect, dextrocardia, pulmonary hypertension, and situs inversus who underwent a successful hernioplasty and hydrocelectomy with a combined spinal epidural anesthesia. This discussion relates to the anesthetic management in such conditions with a special reference to Kartagener's syndrome.

Coronary Artery Bypass Grafting in a Patient with Dextrocardia with Situs Inversus

“…Situs inversus can be associated with cardiac and noncardiac anomalies and include conditions such as duodenal atresia, gastrointestinal malrotation, asplenia, ectopic or horseshoe kidney, various pulmonary abnormalities, ventricular septal defects, atrial septal defects, transposition of the great vessels, double-outlet right ventricle, and more [ 2 , 4 – 6 , 8 ]. Dextrocardia can be associated with similar conditions including asplenia, polysplenia, and multiple noncyanotic congenital heart defects [ 9 ]. However, some sources say situs inversus totalis rarely occurs with other cardiac malformations, while another cites an increase to 3–5% prevalence of congenital heart disease from 1% in the general population [ 2 , 7 ].…”

“…Our patient required a left internal jugular central venous catheter to provide direct access to the right atrium. This access site not only ensures direct right atrial access but also avoids injury to the thoracic duct [ 2 , 9 ]. Additionally, the vectors of myocyte depolarization and repolarization differ with the anatomic variation and require the electrocardiography leads be placed in reverse to avoid a false picture of ischemia [ 6 ].…”

“…Our case report thus captured a relatively rare anatomic anomaly and demonstrated surgical and anesthetic management alterations implemented to ensure a successful outcome. Successful perioperative management requires anesthesiologists, surgeons, proceduralists, and perioperative care teams to identify, understand, and prepare for alterations and anatomy and pathophysiology that these conditions embody and the potential implications they may have on intraoperative and perioperative management [ 9 ].…”