Abstract
BACKGROUND: Situs inversus with dextrocardia (SI-DC) is rarely associated with congenital heart defects. Traditionally, ventricular septal defect (VSD) in such patients has been managed surgically. Percutaneous VSD device closure in SI-DC, albeit a suitable alternative, has been seldom reported. The present report describes the unique challenges of mirror-image cardiac anatomy and suggests technical modifications for successful percutaneous closure. A 4-year-old boy, previously diagnosed with SI-DC and a moderate-size perimembranous VSD, presented with a history of poor weight gain and dyspnea. A 2D echocardiogram indicated that the septal defect was suitable for device closure. The procedure was adapted to account for the altered cardiac anatomy by adjusting the fluoroscopic angles and wire-torquing maneuvers. A Konar-multifunction occluder device MFO® 7-5mm was successfully deployed via retrograde approach without complications utilizing hemodynamic and echocardiographic guidance. No excess contrast volume or fluoroscopic radiation dose was used during the procedure due to meticulous pre-procedure planning. CONCLUSION: VSD device closure in atypical scenarios like SI-DC is both safe and feasible with thorough pre-procedure planning tailored to the "mirror image" cardiac anatomy.