Abstract
Mirror-image dextrocardia is non-life-threatening but not commonly diagnosed in the clinic. With the internal organs reversed, most of the patients with mirror-image dextrocardia have no clinical symptoms if the dextrocardia is not combined with other intracardiac malformations. Mirror-image dextrocardia is often discovered during other physical check or performing other examinations. In the present study, we reported a successful closure of a left atrial appendage in an 84-year-old patient with mirror-image dextrocardia with atrial fibrillation under the guidance of transesophageal echocardiography (TEE). Detailed perioperative steps of patient procedure description and TEE monitoring were described in this report.
Highlights
Mirror-image dextrocardia, the most common form of cardiac malposition, refers to the dextrocardia with situs inversus, L-loop ventricles, and inverted great arteries resulting from situs inversus with a concordant L-bulboventricular loop [1]
Longterm administration of oral anticoagulants can prevent embolism, some patients are still facing the risk of bleeding, anticoagulation taboo, and thromboembolism even under the anticoagulation treatment, which is the major indication for left atrial appendage occlusion [3]
Keeping in mind that the transesophageal echocardiography (TEE) images of this patient were completely mirrored symmetrical to the TEE images of a normal person, the angles at which the left atrial appendage was observed by TEE should be axisymmetric to the angles that apply to a normal person
Summary
Mirror-image dextrocardia, the most common form of cardiac malposition, refers to the dextrocardia with situs inversus, L-loop ventricles, and inverted great arteries resulting from situs inversus with a concordant L-bulboventricular loop [1]. As the mirror view of a normal heart, its visceral position is opposite to the normal. While some studies reported that about 40-50% of mirror-image dextrocardia patients have other cardiac malformations [2], other patients have normal cardiac structures. Atrial fibrillation is the most common type of tachyarrhythmia. Thromboembolism is one of the most severe complications of atrial fibrillation; the most clinically evident thromboembolic event is ischemic stroke. Longterm administration of oral anticoagulants can prevent embolism, some patients are still facing the risk of bleeding, anticoagulation taboo, and thromboembolism even under the anticoagulation treatment, which is the major indication for left atrial appendage occlusion [3]
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