This is a case report of an unusual case of a patient with dextrocardia and "situs inversus totalis" who presented with unstable angina. Coronary angiography revealed severe main stem and severe triple vessel coronary artery disease. The patient later underwent successful emergency coronary artery bypass graft surgery. To the authors' knowledge this is the first reported case in Malaysia and also, the first ever report in the literature of multiple vessel coronary artery grafting, including the use of the right internal mammary artery.
A baby girl with prenatal diagnosis of complex cardiac anomalies and diaphragmatic hernia was born at 36 weeks of gestation. At 4 hr of life, the baby developed respiratory distress and was intubated. She was found to have right hetetrotaxy with total anomalous pulmonary venous drainage into the portal vein, five hepatic veins draining the liver and intrathoracic herniation of the stomach. The child also developed abdominal distension on the second day of life with passage of scanty meconium. The diagnosis of Hirschsprung's disease (HD) was confirmed by histology. HD in association with right heterotaxy has not been reported earlier. The association of heterotaxy with HD in our patient raises a possible genetic link between the two anomalies that needs further research.
1. Three cases of situs inversus are described and the clinical and aetiological factors are discussed briefly.
2. This abnormality occurring in father and son whose family history indicates a great degree of consaguinity seems to support the view held by Cockayne that it is a recessive inheritance.
3. Situs inversus when complete seems to cause no disability. When incomplete as in examples of isolated dextrocardia, congenital heart diseases are commonly seen in association with it. Other congenital malformations may also co-exist. Recently the syndrome of hypertrophic rhinitis, nasal polyposis and sinusitis and bronchiectasis have been encountered in association with transposition of the viscera.