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LETTER TO EDITOR
Year : 2021  |  Volume : 11  |  Issue : 2  |  Page : 127-128

Pseudodextrocardia delaying the diagnosis of peripartum cardiomyopathy


Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India

Date of Submission31-Mar-2021
Date of Acceptance24-Jul-2021
Date of Web Publication01-Oct-2021

Correspondence Address:
Dr. Gorla Deep Kanth
Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joacc.JOACC_27_21

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How to cite this article:
Bandyopadhyay A, Sahni N, Kanth GD. Pseudodextrocardia delaying the diagnosis of peripartum cardiomyopathy. J Obstet Anaesth Crit Care 2021;11:127-8

How to cite this URL:
Bandyopadhyay A, Sahni N, Kanth GD. Pseudodextrocardia delaying the diagnosis of peripartum cardiomyopathy. J Obstet Anaesth Crit Care [serial online] 2021 [cited 2021 Dec 9];11:127-8. Available from: https://www.joacc.com/text.asp?2021/11/2/127/327404



Dear Editor,

We report an unusual case of pseudo-dextrocardia due to extreme elevation of left hemi-diaphragm as a result of gaseous colonic distension causing delay in diagnosis and management in a parturient with peri-partum cardiomyopathy (PPCM).

A 34-year-old multiparous woman with severe pre-eclampsia, polyhydramnios, and diabetes mellitus presented to labour room emergency with acute onset shortness of breath. On examination, patient was already in labour, had tachycardia (140 beats per minute), high blood pressure (160/110 mm Hg) and low room air oxygen saturation (80%). Chest auscultation revealed bilateral basal crepitation with heart sounds heard better on the right side of chest. 12 lead ECG did not reveal any abnormality and bed side 2D echocardiography was suggestive of dextrocardia with inconclusive evaluation of contractility due to inadequate cardiac visualization window, Post early vaginal delivery of the foetus, patient was intubated in view of worsening respiratory distress and transferred to intensive care unit (ICU). She was started on intravenous magnesium sulfate 1 gram/h, labetalol (200 mg three times a day). Chest X-ray revealed clear lung fields with elevated left hemidiaphragm and apparent dextrocardia [Figure 1]a. She could be weaned off the ventilator early within 8 h.

However, after about 24 h of extubation, she again had respiratory distress requiring non-invasive ventilation. All the findings were reviewed again and a lateral X-ray chest revealed colonic distension to be the cause of elevated left hemi-diaphragm (haustrations present) [Figure 1]b. Placement of orogastric tube and decompressing the stomach did not lead to any improvement [Figure 1]c. 2D echocardiography performed from the right side of the chest revealed normal atrio-ventricular and ventriculo-aortic concordance, with an ejection fraction (EF) of 30%–35%, thus establishing a diagnosis of dextrocardia with situs solitus and PPCM. Tablet labetolol was stopped and patient was started on tablet carvedilol (3.125 mg once a day) and tablet ramipril (2.5 mg once a day). Her oxygen requirement decreased and her respiratory distress improved gradually over the next 48 h.
Figure 1: (a) Chest X-ray PA view showing clear lung fields with elevated left hemidiaphragm and apparent dextrocardia. (b) Chest X-ray showing no improvement with orogastric tube in situ. (c) Left lateral chest X-ray showing colonic distension

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Unusual presentation of pseudo dextrocardia due to extreme elevation of left hemidiaphragm secondary to colonic distension delayed the diagnosis of PPCM and precluded us from instituting appropriate therapy.

True dextrocardia, which is associated with situs inversus, is a rare condition in which the heart resides in the right hemithorax with apex also pointing to the right. The malposition is intrinsic to the heart and not due to extracardiac causes.[1] This condition needs to be differentiated from dextrocardia with situs solitus also known as dextroversion or pseudodextrocardia. Pseudo-dextrocardia is mostly secondary to extracardiac causes like right lung pneumonectomy or hypoplasia, bronchiectasis and left-sided diaphragmatic hernia.[2],[3] Rare cardiac causes like bi-atrial enlargement can also result in pseudodextrocardia.[4]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Maldjian PD, Saric M. Approach to dextrocardia in adults: Review. AJR Am J Roentgenol 2007;188(6 Suppl):S39-49.  Back to cited text no. 1
    
2.
Bharati S, Lev M. Positional variations of the heart and its component chambers. Circulation 1979;59:886-7.  Back to cited text no. 2
    
3.
Kelly MG, McGarvey LP, Lawson JT, Elborn JS. Pseudodextrocardia in bronchiectasis. Hosp Med 2002;63:304-5.  Back to cited text no. 3
    
4.
Lorusso R, Morone M, Farina D, Gelsomino S. Pseudo-dextrocardia: An unusual case of giant biatrial enlargement. J Thorac Cardiovasc Surg 2013;146:e59-61.  Back to cited text no. 4
    


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