Mitral Valve Replacement for a Patient with Mirror-image Dextrocardia / 日本心臓血管外科学会雑誌

ABSTRACT

Dextrocardia is a rarely seen cardiac malposition in which the heart is pointed toward the right side of the chest. A 77-year-old woman was admitted to our hospital with exacerbated exertional dyspnea. Cardiac examinations revealed severe mitral regurgitation due to prolapse of the posterior mitral leaflet in mirror-image dextrocardia (situs inversus, L-loop ventricles, and inverted great arteries). Mitral valve replacement using a bioprosthesis and pulmonary vein orifice isolation were successfully performed. The operative view of the surgeon standing on the left side of the patient showed mirror-image dextrocardia represents left-right reversal compared with normal heart structure. This provided some challenges in establishing cardiopulmonary bypass and performing intracardiac maneuvers. The mitral valve was on the left side of the surgeon and different needle grips, different angle of suturing, and the choice of forehand or backhand suturing were required to obtain secure suturing in the mirror-imaged mitral annulus.