PMC8476783_01
(A) X-ray indicates dextrocardia and cardiac enlargement. (B) CTA reveals transposition of the abdominal organs and (C) confirming L-loop ventricular orientation and concordant atrioventricular connections. (D) Three-dimensional CTA shows normal great artery development and connections. (E) The transesophageal echocardiography shows mitral chordae rupture and (F) severe mitral regurgitation (LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle).
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F1
Chest roentgenogram and computed tomography (CT) showed dextrocardia with an enlarged silhouette and situs inversus totalis (Figures 1A,B). The anatomic diagnosis was mirror-image dextrocardia, L-loop ventricles, and typical related great arteries without associated congenital cardiac abnormalities (Figures 1C,D). The left atrium diameter was 5.8 cm without thrombosis formation (Figures 1E,F and Supplementary Video 1).
(A) Pre-printing digital file of the 3D model embedded with designated ablation lines. (B) View of the three-dimensional printed model. (C) Clamping on the model of the mitral isthmus line during the rehearsal process.
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F2
A stereolithography file of the 3D model embedded with designated ablation lines was generated (Figure 2A), which was then manufactured with soft and flexible resinous material at a ratio of 1:1 (Figure 2B). The easy-to-cut and retractable feature of the 3D model (Supplementary Video 2) allowed us to rehearse the CMP-IV pre-operatively (Figure 2C).
(A) Intraoperative view of the mirror-image dextrocardia. (B) Ablation at the mitral line, black arrow indicates the ruptured chordae. (C) Ablation to the tricuspid annulus, the jaw of the bipolar clamps are placed across the tricuspid annulus. (D) Successful result of saline injection test after mitral valvuloplasty.
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F3
The cardiopulmonary bypass for the patient was routinely performed via a median sternotomy (Figure 3A). OH). Other lesions, which were created using bipolar radiofrequency clamps (AtriCure Inc., Cincinnati, OH), included: (i) bilateral pulmonary veins isolation; (ii) ablation lines connecting the left atrial appendage and the left superior pulmonary vein; (iii) ablation lines connecting the right and the left superior pulmonary veins; (iv) ablation lines connecting the right and the left inferior pulmonary veins, and (v) mitral line lesions (Figure 3B). The entire right atrial lesion sets were created using bipolar radiofrequency clamps, including the annular tricuspid lesions (Figure 3C), superior and inferior vena cava lesion lines, and lesion lines connecting the right atrium incision to the right atrial appendage. The coaptation height was 9 mm after reconstruction of the mitral valve (Figure 3D).