Perioperative Risk Assessment and Anaesthetic Considerations in Cleft Lip Repair for an Infant with Dextrocardia: Strategies in the Absence of Genetic Workup
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Abstract
Background: Cleft lip repair is usually safe in healthy infants, but the presence of dextrocardia raises perioperative concerns because of its frequent association with congenital heart disease and syndromes. In resource-limited settings, clinicians must make decisions without genetic testing or advanced imaging.
Case Presentation: A 3-month-old male infant weighing 5.3 kg presented with a complete right unilateral cleft lip. A chest radiograph revealed dextrocardia. Echocardiography confirmed dextrocardia with situs solitus, normal atrioventricular and ventriculoarterial concordance, preserved biventricular function, and no structural defects (no ASD, VSD, or PDA). Abdominal ultrasound confirmed situs solitus. Nutritional assessment showed mild undernutrition related to feeding difficulty. After nutritional optimization and multidisciplinary evaluation, the surgical team proceeded with primary cleft lip repair under general anesthesia. The procedure used the Fisher technique and was completed without intraoperative complications. The patient recovered uneventfully, resumed oral feeding within 12 hours, and showed good wound healing and weight gain on follow-up.
Conclusion: Isolated dextrocardia does not preclude safe cleft lip repair when echocardiography rules out structural heart disease. In settings without genetic testing, clinicians can achieve good outcomes through structured clinical evaluation, basic imaging, and close multidisciplinary coordination. This case demonstrates how careful perioperative planning and tailored anaesthetic strategies ensure safe surgical repair in a resource-limited environment.
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