A congenital condition known as dextrocardia occurs when the heart is not on the left side of the chest, but on the right. Due to abnormal development during fetal growth, dextrocardia affects less than one percent of the general population. Different kinds of dextrocardia may occur and may be accompanied by other heart abnormalities.
The exact cause of dextrocardia is unknown, but it is believed to result from a defect in the formation of the heart during the first few weeks of pregnancy. A normal heart is a tube-shaped organ that bends to the left and forms four chambers and four valves. Dextrocardia occurs when the heart tube bends to the right rather than the left, creating a mirror image of the normal heart.
The heart is the only organ that is reversed in isolated dextrocardia. In situs inversus, all or most of a person's organs are on the opposite side of the body, resulting in dextrocardia with situs inversus. Dextrocardia characterized by a reversed liver, spleen, stomach, and intestines usually does not cause any problems, as the organs function normally despite being reversed.
However, some people have dextrocardia with other heart defects or organ abnormalities, which can affect their health and quality of life. These defects may include:
Holes in the walls that separate the heart chambers (septal defects)
Narrowing or blockage of the heart valves or blood vessels (stenosis or atresia)
Switching of the positions of the main arteries that carry blood from the heart to the lungs and the body (transposition of the great arteries)
Having only one ventricle (lower chamber of the heart) instead of two (single ventricle)
Having problems with the development or function of the spleen, lungs, liver, or digestive system
These defects can cause symptoms such as:
Difficulty breathing
Bluish skin or lips
Fatigue or weakness
Poor growth or development
Frequent infections
Jaundice (yellowing of the skin and eyes)
Depending on the severity and type of dextrocardia, it can be diagnosed before or after birth. During routine prenatal ultrasound scans, which reveal the position and structure of the heart and other organs, some cases of dextrocardia can be detected. In other cases, dextrocardia is discovered late in life, when a person experiences symptoms or undergoes a chest X-ray or an MRI for another reason.
To confirm the diagnosis of dextrocardia and assess its impact on the heart and other organs, doctors may use various tests, such as:
Electrocardiogram (ECG): This test records the electrical activity of the heart and can show if the heart is on the right side and if there are any abnormal heart rhythms (arrhythmias).
Echocardiogram: This test uses sound waves to create images of the heart and can show the structure and function of the heart chambers, valves, and blood vessels.
Cardiac catheterization: This test involves inserting a thin tube (catheter) into a blood vessel and guiding it to the heart. The catheter can measure the pressure and oxygen levels in the heart and inject a dye to make the blood vessels visible on X-rays.
CT scan or MRI: These tests use advanced imaging techniques to create detailed pictures of the heart and other organs and can show the location and extent of any defects or abnormalities.
In addition to the type and severity of dextrocardia, any associated heart defects or organ abnormalities must be considered when treating the condition. Some individuals with isolated dextrocardia or dextrocardia with situs inversus do not require treatment, since their hearts and other organs function normally. To monitor their heart health and prevent complications, they may only need regular check-ups.
Some people with dextrocardia or heart defects may require medication or surgery to correct these problems and improve their symptoms and quality of life. Medications include:
Antibiotics: These drugs can prevent or treat infections, especially in people who have a missing or nonfunctional spleen, which makes them more prone to infections.
Anticoagulants: These drugs can prevent or treat blood clots, especially in people who have abnormal blood flow in the heart or blood vessels, which increases the risk of clots.
Antiarrhythmics: These drugs can control or prevent abnormal heart rhythms, especially in people who have electrical problems in the heart, which can cause arrhythmias.
Diuretics: These drugs can reduce fluid retention and swelling, especially in people who have heart failure, which means the heart cannot pump enough blood to meet the body’s needs.
The surgery may include:
Repairing or replacing the heart valves or blood vessels that are narrowed or blocked
Closing the holes in the heart walls that allow blood to mix between the chambers
Switching the positions of the main arteries that carry blood from the heart to the lungs and the body
Creating a connection between the heart chambers or blood vessels to improve blood flow
Reconstructing the heart to create two ventricles instead of one
A person's age and overall health determine the type and timing of surgery. Some surgeries may be performed shortly after birth, while others may be performed later in life. Some surgeries may require more than one operation or a combination of procedures. Pacemakers or defibrillators may also be needed after surgery to regulate the heart rhythm of some people.
There is no known way to prevent dextrocardia, as the cause of the condition is unknown. However, some factors may increase the risk of having a baby with dextrocardia or other congenital heart defects, such as:
Having a family history of dextrocardia or other congenital heart defects
Having certain genetic syndromes or chromosomal abnormalities, such as Down syndrome or Kartagener syndrome
Having certain infections during pregnancy, such as rubella or cytomegalovirus
Having certain medical conditions during pregnancy, such as diabetes or lupus
Taking certain medications or substances during pregnancy, such as anticonvulsants, retinoids, or alcohol
To reduce the risk of having a baby with dextrocardia or other congenital heart defects, pregnant women should:
Take folic acid supplements before and during pregnancy to prevent neural tube defects, which can affect the development of the heart and other organs
Get regular prenatal care and screening tests to monitor the health of the mother and the baby and detect any problems early
Avoid smoking, drinking alcohol, or using illegal drugs during pregnancy, as these substances can harm the baby’s development
Avoid exposure to infections, radiation, or chemicals that can affect the baby’s development
Consult their doctor before taking any medications, supplements, or herbal remedies during pregnancy, as some of these products may be harmful to the baby’s development
The condition dextrocardia occurs when the heart is located on the right side of the chest rather than on the left side. There are a variety of types of dextrocardia, and it may be associated with other heart defects or organ abnormalities. Various tests are used to determine the heart's position and structure in order to diagnose dextrocardia. Dextrocardia is treated differently depending on its severity, type, and associated heart defects or organ anomalies. There are some people who do not need any treatment for dextrocardia, while others may need medication or surgery. There is no known way to prevent dextrocardia, but certain factors may increase the risk of giving birth to a baby with dextrocardia or other congenital heart defects. It is crucial that pregnant women take steps to reduce this risk and ensure a healthy delivery and pregnancy.
