Heart On The Flip Side: Navigating Bilateral Duct Stenting In A Rare Congenital Anomaly

Abstract

Background: Situs inversus with isolated levocardia is rare and often associated with severe congenital heart disease. When combined with pulmonary atresia and bilateral patent ductus arteriosus, it presents an even more complex case.

Methods: An 11-day-old full-term male (3.6 kg), presented with central cyanosis and an oxygen saturation of 66%. Echocardiography and CT angiogram (CTA) revealed situs inversus with isolated levocardia, double outlet right ventricle with pulmonary atresia, non-confluent pulmonary arteries, a hypoplastic left ventricle, and a large ventricular septal defect (VSD). The left pulmonary artery was supplied by a PDA from the aortic arch, while the right was supplied by a PDA from the brachiocephalic artery. Additionally, there was total anomalous pulmonary venous return, with pulmonary veins draining into the right atrium and the superior vena cava into the left atrium. Upon arrival, the patient developed desaturation and was started on PGE1 infusion.

Results: Bilateral ductal stenting via axillary access was done to maintain pulmonary blood flow. Post-procedure, oxygen saturation improved to 85%, and an echocardiogram showed good PDA flow. The patient was discharged in stable condition with plans for follow-up.

Conclusion: This case presents a rare combination of congenital anomalies. Bilateral ductal stenting stabilized the patient and delayed high-risk surgery, highlighting the importance of early intervention in managing complex congenital heart disease.