At that time a loud systolic murmur was heard at the cardiac apex
and an emergent transthoracic echocardiogram showed severe systolic anterior motion of mitral valve (SAM) and dynamic obstruction of the left ventricular outflow tract (LVOT) with a mean pressure gradient of 64 mmHg (Figure 1).
Echocardiography showed large masses within the intraventricular cavity and cardiac apex
. The second case was admitted to the Newborn Clinic with the diagnosis of cardiac mass detected at the 29th gestational week.
His cardiac apex
beat was palpated in the 5th Intercostal space mid clavicular line on the right side of his chest.
The trachea was slightly shifted to the left with the cardiac apex
beat far to the left.
Cardiovascular examination revealed a 3/6 systolic murmur at the cardiac apex
and left basilar crepitations on auscultation of the chest.
In this position, all wall segments except the cardiac apex
are well visualized.
Given the pretest probability of 16% in this study of LVSD, the positive predictive value for LVSD of JVD was 64%, S3 gallop was 77%, and displaced cardiac apex
The physical exam with right-sided heart sounds, including a 4th heart sound and a right-sided apex with a palpable liver in the left side, and the radiogram findings with right-sided cardiac apex
and gastric chamber Figure 2 confirmed our suspicion of situs inversus totalis, which was an incidental diagnosis.