A CASE REPORT OF ASD ASSOCIATED SITUS INVERSUS, MIRROR IMAGE-DEXTROCARDIA, AZYGOS CONTINUATION OF IVC AND SITE-ANOMALY OF RIGHT ATRIUM

A 6-year-old girl was admitted with the chief complaint of heart murmur. Chest X-ray film, ECG and abdominal examination disclosed mirror image-dextrocardia with situs inversus. Heart catheterization was performed via femoral route. The catheter passed behind the heart, turned round, and then entered the right ventricle through the azygos vein and SVC, but could not entered the pulmonary artery. Then it was repeatedly performed to the pulmonary artery via the brachial route. There was oxygen saturation step up at the level of the right atrium with a 56% of left to right shunt. Final diagnosis was ASD associated with situs inversus, mirror image-dextrocadia and azygos continuation of IVC. The patient underwent radical operation using extra-corporeal circulation. It was found that the right atrium showed site-anomaly and IVC connected only to the hepatic vein. Fixation of IVC cannula was unstable. ASD was closed with direct suture. She was discharged without any complaints.