Dextroposition of the fetal heart
a short review
Normally the fetal heart lies on left side of the chest at left of the spine with the apex pointing to left.
Dextroposition is defined as most of the normally connected fetal heart, is found on the right side of the fetal chest with the apex pointing to the left .
Dextroposition of the fetal heart is an uncommon finding on prenatal ultrasonography.
When the fetal heart is displaced from the normal position in the chest, intracardiac and extracardiac fetal anomalies may be present. It may be caused by a variety of fetal abnormalities. A reported cause is external compression of the fetal heart and mediastinum, shifting the heart toward the right side of the fetus, as is the case of left-sided congenital diaphragmatic hernia in which the fetal stomach and intestines displaced the heart into the right side of the chest or compression and mass effect
in congenital cystic adenomatoid malformation of the lung.
Hypoplasia of the right lung may result to shift the heart to the right to fill the void in the right hemithorax as has been reported in association with the scimitar syndrome, which is described by dextroposition of the heart, maldevelopment of the right lung, and anomalous pulmonary venous return that drains into the vena cava. A rare cause of cardiac dextroposition in the fetus is the Poland syndrome.
Intracardiac anomalies may be also common in cases of dextroposition, indicating a possible developmental link. Comstock et al have hypothesized that the right-sided fetal heart may be due to abnormal looping during cardiac development.
Although some cases may have chromosomal abnormalities , the finding of dextroposition warrants amniocentesis for karyotype. Rarely dextroposition may be an isolated finding.
So, dextroposition of the fetal heart is an unusual finding frequently associated with intracardiac and extracardiac
anomalies. When dextroposition is noted, a targeted ultrasound, fetal echocardiogram, and fetal
karyotype should be offered.
This findings may be important information for patient counseling.
- Falkensammer CB, Ayres NA, Altman CA, Ge S, Bezold LI, Eidem BW, Kovalchin JP.
Fetal cardiac malposition: incidence and outcome of associated cardiac and extracardiac malformations.
Am J Perinatol. 2008 May;25(5):277-81.
- Karl-LudwigWaag, Steffan Loff, Katrin Zahn, Mansour Ali, Steffen Hien, Markus Kratz,
Wolfgang Neff, Regine Schaffelder, Thomas Schaible : Congenital diaphragmatic hernia: a modern day approach
Seminars in Pediatric Surgery, Volume 17, Issue 4, November 2008, Pages 244-254
- Adam F. Borgida, MD, Anthony Odibo, MB, BS, James F.X. Egan, MD, Danielle Esters, MD, and
Winston A. Campbell, MD : Clinical and ultrasonographic features of dextroposition of the
fetal heart Am J Obstet Gynecol 1998;179:982-4.
- Abdullah MM, Lacro RV, Smallhorn J, Chitayat D, van der Velde ME, Yoo SJ, Oman-Ganes L, Hornberger LK.
Fetal cardiac dextroposition in the absence of an intrathoracic mass: sign of significant right lung hypoplasia.
J Ultrasound Med. 2000 Oct;19(10):669-76.
- Kitagawa, Hiroaki; Nakada, Koonosuke; Fujioka, Teruhiro; Kawaguchi, Fumio; Enami,
Tomotake; et. al. : Unilateral pulmonary agenesis with tracheoesophageal fistula: A case report
Journal of Pediatric Surgery Volume: 30, Issue: 10, October, 1995, pp. 1523-1525
- Sepulveda W. – Poland syndrome: a rare cause of cardiac dextroposition in the fetus.
Prenat Diagn. 2009 Sep;29(9):903-5.
- Ott WJ. The accuracy of antenatal fetal echocardiography
screening in high-risk and low-risk populations. Am J Obstet
- Stumpflen I, Stumpflen A, Wimmer M, Bernaschek G. Effect of
detailed fetal echocardiography as part of routine prenatal ultrasonographic
screening on detection of congenital heart disease.
- Copel JA, Pilu G, Green J, Hobbins JC, Kleinman CS. Fetal
echocardiographic screening for congenital heart disease: the
importance of the four-chamber view. Am J Obstet Gynecol
- Crane JM, Ash K, Fink N, Desjardins C. Abnormal fetal cardiac
axis in the detection of intrathoracic anomalies and congenital
heart disease. Ultrasound Obstet Gynecol 1997;10:90-3.
- Grisaru D, Achiron R, Lipitz S, Yahav J, Hegesh J, Rotstein Z.
Antenatal sonographic findings associated with scimitar syndrome.
Ultrasound Obstet Gynecol 1996;8:131-3./li>
- Comstock CH, Smith R, Lee W, Kirk JS. Right fetal cardiac axis:
clinical significance and associated findings. Obstet Gynecol