Partial situs inversus with levocardia. An unusual combination of anomalies.

AN INSTANCE of a unique combinationi 1A . of anomnalies was recently encountered in ani inifant with eyanotic congenital heart disease who died at the age of 13 months. The clinical course and pathologic finding,s are described. Case History The patient was a femiiale baby, born at full terim after ani uneventful pregnancy. At birth she weighed 6 lbs. and was eyanotic. Heart disease was first diagnosed at the age of 3 muonths. The par-ents had noted poor weight "gaiin, delayed developmiient, and generally poor health. The family history was noncontributory. At 7 mnoiths sh1e weighed 9 lbs. 7 oz. and could not sit up. Physical examuination revealed muarked cyanosis and elubbinig, perhaps miiore mlarked in the toes. The heart rate was reguhir at 150 per miiinute; the heart was not enlarged. A grade I:l systolic mtiurmtiur was heard in the pulmonary areai with a normial second sounid. The liver was felt two fingers enlarged in the epigastrium. The femioral pulsations were normiial. On fluoroseopy the heart was slightly largel than normal, the pulmionary eonus xwas not remarkable. The upper mediastinal shadow was broad and extended well to the right, suggesting extremile dextroposition of the aiorta. The lung fields were oligemic. In the right aniterior obliquie view the aorta arched to the left. In the left anterior oblique positionI the large supraeardiaic shtadow to the right was confirlmed as a lairge dextroposed aorta. The right ventriele wa,is (dimninutive anid did1 not extend as far forward as the aorta above. The puliiionary window was niot clear and the left venitricle was enlarged. An x-ray confirmiied the fluor-oscopic findings (fig. 1). The liver appea-red transposed with the larger lobe on the left, although with barium the stomach was on the left. Serial electrocardiograms were taken (fig. 2). Examlination of the blood revealed a heml-oglobin of 12 Gmii. per 100 ml. and a hematocrit level of 56 per cent. The white cell count was 7,000 per eu. imii.