My daughter-in-law is 26 and 5 months pregnant. They just discovered that her heart is on the right side of her body. The only complaint she has is of feeling exhausted. How will this affect her and the baby? Will she have a normal life expectancy?

Your daughter-in-law now has a new and unique ability armed with this knowledge. She can drive young doctors and nurses to distraction as they search the wrong side of her chest for a heart beat. Dextrocardia (right sided heart) is uncommon, but not really that rare. It comes in several different variations: a heart that is twisted toward the right and not totally "right sided", a heart that is totally right sided alone, or is associated with reversed abdominal organs (we call this "situs inversus": in such a case the stomach is on the right instead of the left while the liver is on the left instead of the right). If abdominal organs are reversed, appendix and gall bladder are too, so the patient can be expected to have the "symptoms wrong".

If there are no associated congenital abnormalities that have been discovered (these are usually found in early childhood), then there is usually no effect on health or longevity. Patients diagnosed with dextrocardia should be evaluated by a cardiologist to assure that no other "surprises" are missed. As far as the exhaustion is concerned, pregnancies with dextrocardia have the same problems as any other pregnancies. Regular obstetrical check-ups with prevention of anemia by prenatal vitamins, a good diet, and cessation of smoking do promote healthy pregnancies and babies.

It is important for both patient and doctor to know on which side the heart and vital organs are located to avoid making errors in diagnosis and treatment. Since the uterus (womb) is in the middle, the heart position should not have any effect on the pregnancy. And the babies are not usually bothered by which side the heart is on. It is important that her doctor knows of this diagnosis and that it is clearly marked on her medical records to minimize any possibility of error.

And while thinking about babies

In the past 12 calendar months, 3 of our children have died in Massachusetts while walking or playing a team sport on a school field. They did so without injury, without warning, and in the company of others.

Occasionally, an attorney requests that I evaluate who should be blamed or found at fault. Sometimes, a grieving relative expresses ‘heartache'. And more often, the evening news intrudes with the usual: who, what, where, when, how and why. Each of us, in his or her own way trying to cope with human tragedy. Massachusetts is no different than any of the 49 other states, or most countries. Such events occur all too frequently, and far more than we even hear. Indeed, if a coach, or an elderly man walking to promote his health, or a woman walking a child were to die suddenly in the same area, or on the same field, we would all take it in stride. It happens. While the death is a severe blow to the family and often to the community, the worst tragedy is that in many cases, the child could have been saved to lead a useful and productive life. The family could have been saved the anguish.