Dextrocardia is an abnormality in which the heart is located in the right half of the chest and not on the left as normal. Normally the heart is located in the middle part of the thorax, with its vertex or apex inclined to the left, but in this malformation of genetic origin this situation varies and the heart is located inclined towards the right side of the thorax. This phenomenon occurs during the fourth week of embryonic development, at which time the primitive heart tube bends to the right when it normally should bend to the left.
Dextrocardia is generally accompanied by an abnormality called ‘situs inversus’, which consists of the organs being on the opposite side from where they should be. This situation only affects odd-numbered organs that are located on a certain side of the body, for example, the liver, pancreas or stomach. In some cases, however, it can also be associated with ‘situs ambigus’. In this case it may be only one of the organs that is inverted and the others are in their normal positions.
Causes of dextrocardia
genetic factor
The baby’s heart fully develops during the first weeks of pregnancy. In dextrocardia, the heart turns and points toward the right side of the chest, instead of the left side. The reasons are not clearly identified although there is a genetic load.
Another reason why a patient may have dextrocardia is that the neurotransmitter serotonin (5HT) is altered during embryo development and causes ‘situs inversus’ and other cardiac problems.
There are various types of dextrocardia. The simplest only has the heart (and sometimes other organs) on the right side and does not present major complications. In other cases of dextrocardia, it is associated with other cardiac anomalies such as double ventricular outlet or narrowing of the pulmonary valve. It is also common for there to be only one ventricle when there are normally two.
Babies may have functional problems in some of the abdominal and chest organs, causing a generalized abnormality called heterotaxy, which consists of most of the organs not being in place. It can also cause a deficient gallbladder system and serious abnormalities in the heart, lungs, and intestines.
Symptoms of dextrocardia
Signs only occasionally
Dextrocardia only occasionally presents some symptoms. Among the most common are the feeling of tiredness, darkened skin in some parts of the body or yellowish in others, breathing problems and a certain ease for infections to occur.
Diagnosis of dextrocardia
Physical examination
The doctor would perform a physical examination to start and question the patient about the symptoms they are experiencing. Then you will perform some tests such as a chest x-ray, echocardiography, magnetic resonance imaging, electrocardiogram and tomography scans.
Dextrocardia treatment and medication
Treatment is not always necessary
A dextrocardia that presents a complete mirror image and does not show cardiac problems does not require any treatment. The type of treatment that will be implemented will vary depending on the heart problems that the baby has. The doctor may resort to surgery.
Babies who have simple dextrocardia have an absolutely normal life expectancy. If dextrocardia is associated with other heart problems, the prognosis is very variable. For example, if the baby does not have a spleen, he or she may have repetitive infections.
Possible complications include intestinal obstruction, heart failure, pneumonia, and infertility in men (Kartagener syndrome). In an extreme case, it can cause death.
Prevention of dextrocardia
Without prevention
There is no way to prevent dextrocardia, although if there is a hereditary history, the possibility of getting pregnant must be considered because it is likely that the baby will inherit this anomaly.
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