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Pulmonary anatomy seems to be normal, with right lobar bronchi on the right and two on the left; the gastric bubble was on the left side (arrow), and liver on the right side (+). (B) Depression of the left anterior chest wall and nipple defect (arrows).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Poland syndrome is a rare congenital disorder characterized by aplasia or hypoplasia of the ipsilateral chest muscles, major and minor pectoralis, associated with abnormalities of the hand, such as brachydactyly, syndactyly or underdeveloped (vestigial) fingers.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a> This clinical manifestations are extremely variable; breast and nipple abnormalities may also occur, and axillary hair is sometimes sparse or abnormally placed. Other very rares anomalies like vertebral defects, renal aplasia or hypoplasia, lower limbs defects or Möbius syndrome can be associated.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Rarely all of these features are recognized in the same patient.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">This syndrome has been estimated to occur in 1:20,000 to 1:30,000 newborns, and it is more common in male than in female individuals, and also more frequent on the right side.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The cause of the Poland syndrome remain still unkown, however some reports suggest that it may result from a disruption of blood flow (of the subclavian and vertebral arteries) during the sixth week of gestation.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> But it is also thought that a possible genetic inheritance could be related, however no genes have been identified.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Differential diagnosis of dextrocardia with sinus solitus must included syndromes such as Scimitar syndrome and Cantrell's syndrome, which is characterized by defects of the midline abdominal wall. But none of them are associated with hypoplasia or agenesia of pectoralis muscle, which is specific of Poland syndrome.</p><p id="par0025" class="elsevierStylePara elsevierViewall">We present a case of 18 months-old male, with no relevant anomalies in the family was referred to the Pediatric Cardiologist because of a dextrocardia in the radiological examination. The chest X-ray demonstrated an isolated dextrocardia (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A), with an asymmetric thorax but without ribs defects, and normal abdominal organs arrangement.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The ecocardiography revealed a displacement of the heart's large axis to the right side with the heart apex in the midline of the thorax (mesocardia), and a left aortic arch. No evidence of intracardiac malformations, neither alteration of the grand vessels anomalies were seen.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The physical exam showed a smaller left areola, also located slightly higher than the right one. Also a hypoplasia of subcutneous tissue on the left wall chest could be noted, which suggested a defect in the left pectoralis muscle (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). But there were no evidence of an associated syndactylism or brachysyndactyly anomaly.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Clinically, patient did not show any functional disability, neither deficiencies in muscle strength. Further systemic examinations were carried out, excluding renal anomalies.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Regarding to the treatment, conservative management was chosen with physical therapy, which may be beneficial in improving strength and mobility. In the future, reconstructive surgery may be considered to develop symmetry between the affected and unaffected side.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Left-sided Poland syndrome is uncommon, but mainly its association with dextrocardia is extremely rare. To date, only 14 cases with similar characteristics have been described.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Our patient as well as having a malformation of the left pectoralis muscle, showed a morphological normal heart displaced to the right side of the chest. This finding called dextroposition, has an incidence which varies from 30,000 to 1 in 36,000 newborns<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> and it can be presented as part of situs inversus (heterotaxia), or an isolated situs solitus defect.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Because both isolated dextroposition and Poland syndrome are very rare, we believe that the relationship between dextrocardia and PS is not a coincidence, whereas dextroposition may be part of the Poland syndrome, especially left-sided.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Moreover, every Polar syndrome with dextrocardia reported had associated any rib defect. Different from these reported cases, our patient did not show any rib abnormality, which shows that is not necessary any rib defect to displace the heart.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0070" class="elsevierStylePara elsevierViewall">This research received no specific grant from any funding agency, commercial or not-for-profit sectors.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 548 "Ancho" => 1255 "Tamanyo" => 72376 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Chest X-rays demonstrated an isolated dextrocardia (*), with an asymmetric thorax but without ribs defects. Pulmonary anatomy seems to be normal, with right lobar bronchi on the right and two on the left; the gastric bubble was on the left side (arrow), and liver on the right side (+). (B) Depression of the left anterior chest wall and nipple defect (arrows).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dextrocardia in patients with Poland syndrome: phenotypic characterization provides insight into the pathogenesis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Torre" 1 => "A. Baban" 2 => "A. Buluggiu" 3 => "S. Constanzo" 4 => "L. Bricco" 5 => "M. Lerone" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "2010" "volumen" => "1395" "paginaInicial" => "1177" "paginaFinal" => "1182" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Poland syndrome: description of an atypical variant" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G.A. Ferraro" 1 => "A. Perrotta" 2 => "F. Rossano" 3 => "F. D’Andrea" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Aesth Plast Surg" "fecha" => "2005" "volumen" => "29" "paginaInicial" => "32" "paginaFinal" => "33" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Poland's syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.R. Moir" 1 => "C.H. Johnson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.sempedsurg.2008.03.005" "Revista" => array:6 [ "tituloSerie" => "Semin Pediatr Surg" "fecha" => "2008" "volumen" => "17" "paginaInicial" => "161" "paginaFinal" => "166" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18582821" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of Poland syndrome associated with dextroposition" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Lacorte" 1 => "M. Marsella" 2 => "P. Guerrini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1824-7288-36-21" "Revista" => array:5 [ "tituloSerie" => "Ital J Pediatr" "fecha" => "2010" "volumen" => "36" "paginaInicial" => "21" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20170539" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Poland's syndrome revisited" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.A. Fokin" 1 => "F. Robicsek" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0003-4975(02)04161-9" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2002" "volumen" => "74" "paginaInicial" => "2218" "paginaFinal" => "2225" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12643435" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015600000003/v1_202102051000/S2387020620306562/v1_202102051000/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015600000003/v1_202102051000/S2387020620306562/v1_202102051000/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620306562?idApp=UINPBA00004N" ]
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Letter to the Editor
Cardiac dextroposition associated to Poland syndrome
Síndrome de Poland asociado a dextrocardia
Elena Guadalupe Corella Aznar
, Ariadna Ayerza Casas, Daniel Palanca Arias, Lorenzo Jiménez Montañés
Autor para correspondencia
Unidad Cardiologia Pediátrica, Hospital Infantil Miguel Servet, Zaragoza, Spain