PMC10435878_01
(A) preoperative transesophageal echocardiography showing mitral and pulmonary valve regurgitation; (B) computed tomography angiography of the chest and upper abdomen, demonstrating a rightward orientation of the left atrium, and liver at the left side; (C) computed tomography angiography with 3D reconstruction of the chest, illustrating a right-sided location of the left atrium and ventricle from the sternum. Ao, aorta; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle. Asterisk, right pulmonary artery.
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F1
A 50-year-old man diagnosed with dextrocardia and situs inversus totalis (DSIT) was referred at our institution with symptoms of exertional dyspnea due to severe mitral and pulmonary valve regurgitation for surgical replacement of both valves (Figure 1A). Preoperative computed tomography angiography (CTA) of the chest and abdomen as well as a transthoracic echocardiography (TTE) confirmed the DSIT, citing a light rightward rotation of the apex around the central axis, and showed a very complex anatomy of the heart (Figure 1B). The left atrium (LA) and left ventricle (LV) were placed on the right side, the right atrium (RA) and the right ventricle (RV) on the left side, with the apex lying behind the sternum (Figure 1C).
(A) right anterior mini-thoracotomy through a 5 cm skin incision at the fourth right intercostal space. (B) The patient at 6th postoperative day with the minimal incision right.
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F2
Right anterior mini-thoracotomy through 5 cm skin incision at the fourth right intercostal space (ICS) was performed (Figure 2A). He was discharged home on the 10th postoperative day (Figure 2B).