J Korean Med Sci.  2017 Dec;32(12):2069-2072. 10.3346/jkms.2017.32.12.2069.

A Case of Multiple Cardiovascular and Tracheal Anomalies Presented with Wolff-Parkinson-White Syndrome in a Middle-aged Adult

• Shi H
• Sohn S
• Wang S
• Park S
• Lee S
• Kim SY
• Jeong SY
• Kim C

• KMID: 2396388
• DOI: http://doi.org/10.3346/jkms.2017.32.12.2069

Abstract

Congenital cardiovascular anomalies, such as dextrocardia, persistent left superior vena cava (SVC), and pulmonary artery (PA) sling, are rare disorders. These congenital anomalies can occur alone, or coincide with other congenital malformations. In the majority of cases, congenital anomalies are detected early in life by certain signs and symptoms. A 56-year-old man with no previous medical history was admitted due to recurrent wide QRS complex tachycardia with hemodynamic collapse. A chest radiograph showed dextrocardia. After synchronized cardioversion, an electrocardiogram revealed Wolff-Parkinson-White (WPW) syndrome. Persistent left SVC, PA sling, and right tracheal bronchus were also detected by a chest computed tomography (CT) scan. He was diagnosed with paroxysmal supraventricular tachycardia (PSVT) associated with WPW syndrome, and underwent radiofrequency ablation. We reported the first case of situs solitus dextrocardia coexisting with persistent left SVC, PA sling and right tracheal bronchus presented with WPW and PSVT in a middle-aged adult. In patients with a cardiovascular anomaly, clinicians should consider thorough evaluation of possibly combined cardiovascular and airway malformations and cardiac dysrhythmia.

Keyword

Dextrocardia; Superior Vena Cava; Pulmonary Artery; Bronchus; Wolff-Parkinson-White Syndrome

MeSH Terms

Adult*
Arrhythmias, Cardiac
Bronchi
Catheter Ablation
Dextrocardia
Electric Countershock
Electrocardiography
Hemodynamics
Humans
Middle Aged
Pulmonary Artery
Radiography, Thoracic
Tachycardia
Tachycardia, Supraventricular
Thorax
Vena Cava, Superior
Wolff-Parkinson-White Syndrome*

Figure

• 

  Fig. 1 The initial chest X-ray, showing dextrocardia.

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  Fig. 2 Electrocardiograms. (A) An initial 12-lead electrocardiogram showed a heart rate of 190 bpm and wide QRS complex tachycardia. (B) After administration of intravenous adenosine, a follow-up electrocardiogram revealed bradycardia with a shortened PR interval and a slurring and slow rise of the initial upstroke of the QRS complex (black arrows).

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  Fig. 3 Chest CT images. (A) An axial chest CT image reveals persistent left SVC (arrow) and PA sling. (B, C) Both axial and coronal chest CT images reveal right tracheal bronchus. CT = computed tomography, SVC = superior vena cava, PA = pulmonary artery.

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