Dextrocardia classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: José Eduardo Riceto Loyola Junior, M.D.[2]

Overview

There is no established system for the classification of dextrocardia. Despite that, it has been proposed to categorize it according to its relationship with some congenital cardiac anomalies including situs inversus, situs solitus, and situs ambiguous.

Classification

There is no established system for the classification of dextrocardia but it may be categorized with some of the congenital cardiac anomalies that may be seen in association with it:

Dextrocardia Types	Description
Dextrocardia with situs solitus	Dextrocardia with normally related great arteries and D-transposition (complete transposition) or L-transposition (congenitally corrected transposition) of the great arteries. Some examples include dextrocardia with D-loop ventricles and normally related great arteries, with L-loop ventricles and L-TGA (congenitally corrected TGA). Embryologic failure of the final leftward shift of the ventricles during development results in dextrocardia with situs solitus, D-loop ventricles, and normally related great arteries.
Dextrocardia with situs inversus	May present with dextrocardia with inversely related great arteries and D-transposition (congenitally corrected transposition) or L-transposition (“uncorrected” transposition) of the great arteries. An example is dextrocardia with D-loop ventricles and D-TGA (congenitally corrected TGA).
Dextrocardia with situs ambiguous (either polyspenia or asplenia)	Dextrocardia with any of the above relationships between the ventricles and great vessels.

The table below shows the three possible basic truncoconal morphologies that occur in dextrocardia:

Truncoconal Morphologies in Dextrocardia	Description
Dextrocardia without TGA	Aorta and pulmonary artery in a normal relation Most common type Occurs in about 78% of cases
Dextrocardia with TGA	Both vessels parallel to each other with the aorta emerging from the anterior ventricle in an anterior position and the pulmonary artery posterior to the aorta Occurs in about 22% of cases.
Dextrocardia with a common trunk	A single vessel emerges from the heart Least common type

There are two possible ventricular positions that could be seen in dextrocardia:

Position of the ventricles	Description
Normal position	The dorsal ventricle is located on the right and the ventral ventricle is located on the left.
Ventricular inversion	The ventral ventricle is located on the right and the dorsal located on the left