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D EXTROTATION of the heart occurring in rheumatic heart disease is rare. Only Schreiner and Lyons' and Steinberg and Ayres 2 have reported cases. Dextrorotation of the heart is a congenital anomaly in which the heart is displaced toward the right hemithorax and rotated in a counterclockwise direction on its longitudinal axis. This results in an altered spatial relation of the cardiovascular structures within the thorax. The apex of the heart lies behind the sternum, and the two ventricles are side by side. The right ventricle forms the right cardiac border, and the left ventricle is no longer the posterior ventricle but becomes part of the anterior aspect of the heart. The great vessels arise normally but the rotation to the right causes medial displacement of the pulmonary artery and opening of the loop between the ascending and descending aorta. Dextrorotation may be simulated by turning a patient with a normally placed heart into the left anterior oblique position.2' 3 Recent reports 2-4 have dealt with dextrorotation of the heart and differentiated it from other spatial derangements. Dextrorotation of the heart has been frequently associated with other congenital cardiac anomalies,2 3 but only rarely with acquired rheumatic valvular heart disease. The purpose of this paper is to report a third case of dextrorotation of the heart and rheumatic mitral stenosis.

Dextrorotation of the Heart in Rheumatic Mitral Stenosis