Isolated levocardia: prenatal diagnosis and management

Area of Science:

• Medical Genetics
• Fetal Medicine
• Pediatric Cardiology

Background:

• Isolated levocardia (IL) is a rare situs anomaly characterized by normal left-sided heart position and dextroposition of abdominal viscera.
• While IL is documented in children and adults with cardiac defects, prenatal diagnosis remains infrequently reported.

Observation:

• This report details two prenatal cases of isolated levocardia diagnosed via ultrasonography and magnetic resonance imaging (MRI).
• Both fetuses exhibited normal cardiac function throughout gestation, requiring no postnatal cardiac intervention.
• Abdominal viscera positioning varied, with one case managed conservatively and the other necessitating surgery for intestinal malrotation.

Findings:

• Prenatal diagnosis of IL is feasible using advanced imaging techniques like MRI.
• Fetal cardiac function can be normal in IL, but associated gastrointestinal anomalies, such as intestinal malrotation, pose significant risks.
• The prognosis of IL is influenced not only by cardiac status but also by the potential for life-threatening bowel complications.

Implications:

• Prenatal identification of IL is vital for proactive management of potential gastrointestinal issues, even in the absence of congenital heart disease.
• Routine fetal ultrasonography should be vigilant for signs of IL, with MRI recommended for detailed visceral anatomy assessment.
• Postnatal surveillance for bowel problems, particularly after initiating oral feeding, is essential for infants diagnosed with IL.