iarjaccIARJACCIARJACC2709-1880https://doi.org/10.47310/iarjacc.2025.v06i02.002“Right Heart” on the “wrong side”? - Anaesthesia Management of Dextrocardia posted for Hysteroscopic PolypectomyTipparajuVarshaN.SupriyaConsultant Anaesthesiologist, Srinivasa Hospital, Hyderabad, IndiaConsultant Obstetrician and Gynaecologist, Srinivasa Hospital, Hyderabad, IndiaBackground: Dextrocardia is a rare congenital cardiac positional anomaly in which the heart is situated in the right hemithorax, with its apex directed toward the right side. When associated with situs inversus totalis, all thoracoabdominal organs are arranged in a mirror-image pattern. The incidence is approximately 1 in 10,000 live births, and most individuals remain asymptomatic until incidentally diagnosed during evaluation for unrelated conditions. Case Presentation: A 55-year-old hypertensive postmenopausal woman presented with complaints of bleeding per vaginum for two days. She was scheduled for hysteroscopic polypectomy and endometrial biopsy. During pre-anaesthetic assessment, dextrocardia was suspected on physical examination and confirmed by electrocardiography and chest radiography. Further evaluation with echocardiography and ultrasonography revealed dextrocardia with situs inversus totalis and normal cardiac function (EF 66%). The procedure was performed under spinal anaesthesia with appropriate monitoring and reversed ECG lead placement. The surgery and postoperative recovery were uneventful, and the patient was discharged on the first postoperative day. Conclusion: This case highlights the importance of thorough pre-anaesthetic evaluation, as dextrocardia may remain undiagnosed until incidentally discovered. Anaesthetic management of such patients requires special considerations including reversal of ECG leads, careful positioning of defibrillator paddles, and vigilance for potential associated anomalies. Awareness and appropriate perioperative planning ensure safe anaesthetic management in patients with dextrocardia and situs inversus totalis.