BACKGROUND: Situs inversus totalis is a rare congenital anomaly that results in a perfect mirror image of the systemic organs. We report a case of MICS-AVR through left anterior mini-thoracotomy for severe aortic stenosis in situs inversus totalis.
CASE: An 89-year-old woman was diagnosed with severe aortic valve stenosis with palpitations & dyspnea and referred to us for AVR. At the same time, a CT scan of her entire body showed complete internal retroversion. Prior to the operation, all equipment was placed in a mirror image of their standard positions. In general anesthesia, tPM was inserted from the left internal jugular vein & cardiopulmonary bass (CPB) was started with right arterial & venous femoral cannulation. A left anterior mini-thoracotomy through a 5-cm skin incision at the 3rd left intercostal space was performed. After opening the pericardium, left ventricular vent was placed through the left upper pulmonary vein. The aorta was cross-clamped & blood cardioplegia was administered in an antegrade fashion. The aorta was incised transversely, & the native aortic valve was totally excised. After annulus sizing, annular sutures were placed, & a 21-mm biological Trifecta GT was implanted. After closing the aortotomy & the aorta was de-clamped, the patient was weaned from CPB. The CPB & cross-clamp times were 222 and 188 min. Our patient had an uneventful recovery after the surgery, and discharged home on the fifteenth postoperative day.
CONCLUSIONS: We could perform MICS-AVR through left anterior mini-thoracotomy in situs inversus totalis safely.
