Upgrading from a Dual-chamber Pacemaker to a Cardiac Resynchronization Therapy Defibrillator in Situs Inversus Totalis with Dextrocardia Following Mitral Valve Replacement and Tricuspid Annuloplasty Using a Left-sided Approach

Amato Santoro,Caludia Baiocchi,Elodi Bacci

doi:10.19102/icrm.2021.120101

Abstract

A 71-year-old female patient was referred to our center to upgrade a dual-chamber pacemaker to a cardiac resynchronization therapy defibrillator (CRT-D) following the detection of worsened systolic function (ejection fraction:25%–30%) via transthoracic echocardiography. The patient had situs inversus totalis with dextrocardia. She had undergone mitral valve replacement and tricuspid annuloplasty in July 2019, with a concomitant left upper pulmonary lobectomy for neoplasm, detected at cardiac tomography incidentally. In January 2020, we performed an upgrade of the preexisting device to a CRT-D system because the patient developed heart failure, reduction in systolic function, and numerous nonsustained ventricular tachycardias. The right ventricular lead that had been previously implanted was extracted. To facilitate the intervention, we decided to flip the fluoroscopic image, obtained with a right-anterior oblique view, by 180° (right–left), creating the optical impression of a levocardial position.

Highlights

Situs inversus totalis (SIT) is a congenital condition in which the major visceral organs are reversed or mirrored from their normal positions
DXC is classic mirror-image DXC, in which the anterior– posterior relationships of the various parts of the heart are normal but their right-to-left orientation is reversed. This condition is commonly associated with the liver shadow on the left and the stomach bubble on the right on X-ray films constituting the box of SIT.[2]
This report describes the procedure of upgrading from a dual-chamber pacemaker to a cardiac resynchronization therapy defibrillator (CRT-D) system in a patient with SIT and DXC suffering from heart failure

Summary

Introduction

Situs inversus totalis (SIT) is a congenital condition in which the major visceral organs are reversed or mirrored from their normal positions. DXC is classic mirror-image DXC, in which the anterior– posterior relationships of the various parts of the heart are normal but their right-to-left orientation is reversed. This condition is commonly associated with the liver shadow on the left and the stomach bubble on the right on X-ray films constituting the box of SIT.[2] This report describes the procedure of upgrading from a dual-chamber pacemaker to a cardiac resynchronization therapy defibrillator (CRT-D) system in a patient with SIT and DXC suffering from heart failure. The systolic function was improved (EF: 45%)

Discussion

Conclusions