# VSD device closure in situs inversus with dextrocardia: technical challenges and solutions: a case report

## TL;DR

This case report describes a successful percutaneous closure of a heart defect in a child with a rare condition involving mirrored internal organs.

## Contribution

The paper presents a novel approach to device closure in a rare anatomical condition using tailored technical modifications.

## Key findings

- Percutaneous VSD closure in SI-DC is feasible with adjusted fluoroscopic angles and wire techniques.
- The procedure was performed safely without excess contrast or radiation due to meticulous planning.
- A Konar-MFO device was successfully deployed via a retrograde approach in a mirror-image anatomy.

## Abstract

Situs inversus with dextrocardia (SI-DC) is rarely associated with congenital heart defects. Traditionally, ventricular septal defect (VSD) in such patients has been managed surgically. Percutaneous VSD device closure in SI-DC, albeit a suitable alternative, has been seldom reported. The present report describes the unique challenges of mirror-image cardiac anatomy and suggests technical modifications for successful percutaneous closure.

A 4-year-old boy, previously diagnosed with SI-DC and a moderate-size perimembranous VSD, presented with a history of poor weight gain and dyspnea. A 2D echocardiogram indicated that the septal defect was suitable for device closure. The procedure was adapted to account for the altered cardiac anatomy by adjusting the fluoroscopic angles and wire-torquing maneuvers. A Konar-multifunction occluder device MFO® 7-5mm was successfully deployed via retrograde approach without complications utilizing hemodynamic and echocardiographic guidance. No excess contrast volume or fluoroscopic radiation dose was used during the procedure due to meticulous pre-procedure planning.

VSD device closure in atypical scenarios like SI-DC is both safe and feasible with thorough pre-procedure planning tailored to the "mirror image" cardiac anatomy.

The online version contains supplementary material available at 10.1186/s43044-025-00665-9.