Left isomerism diagnosed at prenatal period: a case report

Objective

Heterotaxy refers to abnormal situs of visceral organs in thorax or abdomen. Clinic is reflected in two ways: left isomerism / polisplenia, right isomerism / asplenia. Left isomerism is both atria of the heart's replace to left side and could include atrioventricular septal defect, or structural heart disease, the inferior vena cava ongoing azygos vein, heart block and viscerocardiac heterotaxy. Because of fetal arrhythmia and bradycardia, fetal non-immune hydrops and intrauterine death rates are common. In this study, left isomerism case diagnosed in early pregnancy is presented.

Case(s)

24 years old woman, whom has had five abortions and two healthy child, has consulted to our clinic because of fetal nuchal translucency has measured 3.32 mm and the risks for trisomy 13 and trisomy 18 in combined test has calculated 1/50. Patient was referred to our center at 15 weeks 2 days of gestation. In obstetric ultrasonography; stomach was observed on the right, fetal bradycardia (65 beats / min) and atrioventricular septal defect (AVSD) were detected. After giving information to parents about the clinical course and prognosis, termination has recommended which patients did not accept. At 23 weeks obstetric ultrasound persistan fetal bradycardia (67 beats / min) was observed. Again terminate of the pregnancy is suggested, but the family did not accept.
Patient, at gestational of 35 weeks 1 day was admitted to our clinic with complaint of not feeling fetal movements. The absence of the fetal heart beat has observed. Ex fetus, 2210 g weigh, was delivered vaginally. Family refused an autopsy.

Conclusion

Within the early weeks of gestation, the monitoring of fetal stomach on the right, detection of fetal bradycardia and AVSD is essential in prenatal diagnosis of left isomerism. The fetus with the diagnosis of isomerism may develop non-immune hydrops and fetal death could have been seen and should be kept in mind.

Keywords

Left isomerism, bradycardia, atrioventricular septal defect

	File/Dsecription
	Figure 1 Left isomerism, nuchal translucency measurement
	Figure 2 Left isomerism, fetal bradycardia (61 bpm)
	Figure 3 Left isomerism, abnormal fetal heart situs