Left Aortic Arch and Right Superior Vena Cava in Mirror-Image Dextrocardia with Tetralogy

Interesting clinical instruction in mirror-image relationships, especially of major arterial and venous anatomy, was provided by a unique case of tetralogy of Fallot with mirror-image dextrocardia. Besides situs inversus, there was left aortic arch, interruption of the inferior vena cava with right hemiazygous continuation and persistent right superior vena cava which emptied into a giant coronary sinus (mirror-image or right aortic arch and hemiazygous vein draining into a persistent left superior vena cava). Right heart catheterization and caval cannulation at surgery could be achieved only by passage through the coronary sinus.