Transseptal Approach for Mitral Valve Replacement in Dextrocardia with Situs Inversus Totalis: A Case Report and Review of the Literature

Abstract

<jats:p>We consider mitral valve disease requiring surgery in a patient with dextrocardia and situs inversus totalis to be an exceptional finding. The transseptal approach for mitral valve surgery in dextrocardia represents a technical challenge owing to its anatomic particulars. We present the case of a 56-year-old female patient who had been diagnosed with situs inversus totalis in childhood and with chronic atrial fibrillation in adulthood and was under oral anticoagulant treatment. She was referred to our hospital for increasing dyspnea and palpitation. Transthoracic echocardiography detected severe mitral regurgitation associated with moderate tricuspid regurgitation, with normal left and right ventricular function. Contrast chest computed tomography (CT) and preoperative abdominal CT showed both dextrocardia and situs inversus totalis, with normal continuity of the inferior vena cava. Biatrial cannulation was performed with the surgeon standing on the right side of the patient, and mitral valve replacement using a transseptal approach was performed with the surgeon standing on the left side of the patient. In this case report, we emphasize the rarity of mitral valve disease in a patient with dextrocardia and the inherent potential difficulty that can appear in this particular anatomic condition.</jats:p>

Minimally invasive mitral valve replacement and concomitant Cox-Maze IV procedure using radiofrequency energy in situs inversus totalis: A case report

“…No mortality or serious cardiovascular complications were reported. The majority of cases were performed through standard sternotomy [ [6] , [7] , [8] , [9] ]. Minimally invasive surgery was the effective approach on SIT patients when the pre-operative data showed favorable anatomy of the heart and great vessels [ 10 , 11 ]; particularly when the conventional sternotomy approach was contraindicated [ 12 ].…”

Therapy of Patients with Cardiac Malposition

“…Mitral valve abnormalities producing severe mitral regurgitation have been seen in dextrocardia. Surgical repair [ 127 ] or replacement [ 128 , 129 , 130 ] of the mitral valve can be safely performed [ 127 , 128 , 129 , 130 ].…”