My son required shunt for plural effusion at 20 weeks gestation. The doctors thought that the heart was shifted due to the large amount of fluid but when the fluid did not return after birth and the heart remained on the right side he was diagnosied with dextrocardia with abdominal organs normal. He required intubation shortly after birth which he remained on for 11 days. During his stay in the NICU it was noted he had an elevated left diaphragm with partial paralysis, and it is thought that the plural effusion was caused by possible lymphangectasia (by CAT scan). It is unknown why left diaphragm is elevated but some have thought that it could be due to the shunt placement as it was a left sided plural effusion. They are currently looking into different diagnosises that would explain the dextrocardia (ciliary dyskinesia) with mixed opinions. Could the left diaphragm elevation cause the dextrocardia (heart is not just shifted, apex is pointing right).
When a child has dextrocardia (heart in the right chest) with normal abdominal organ arrangement (situs), there is usually a very high association (> 90%) with other structural heart abnormalities. That is the most important issue here. If your child is fortunate and does not have any serious heart issues except for the cardiac location, then they fall into the minority of children who have dextrocardia with normal abdominal situs. It is unlikely that anyone will be able to tell you the cause of the left hemi-diaphragm dysfunction, as there were several issues going on with the effusion and shunt. Again, what is most important is that the child weaned off the ventilator and is breathing spontaneously. If the hemi-diaphragm is "partially" paralyzed it might even improve with time. It sounds like your doctors are doing the appropriate work up for the dextrocardia and other systemic issues. Good luck.
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