Dextrocardia is a cardiac positional anomaly in which the heart is located in the right hemithorax with its base-to-apex axis directed to the right and caudad. The malposition is intrinsic to the heart and not caused by extracardiac abnormalities. There are three types of situs: situs solitus (normal), situs inversus (mirror image of normal), and situs ambiguous. Situs applies to the pattern of the viscera as a whole and to each asymmetric viscus itself, such as the lung, liver, spleen, and gastrointestinal tract. Situs also applies to the heart as a whole and to each of the cardiac chambers because each is asymmetric1
Dextrocardia with situs inversus, L-loop ventricles, and inverted great arteries results from situs inversus with a concordant L-bulboventricular loop. This is the mirror image of normal and has been called “mirror-image dextrocardia”1.
This is the most common type of dextrocardia in the general population (present in one or two in 20,000). The incidence of congenital heart disease is low, ranging from 2% to 5%2. Dextrocardia with situs solitus, D-loop ventricles, and normally related great arteries results from failure of the final leftward shift of the ventricles during embryologic development. This has been termed “dextroversion” because the heart appears to be rotated into the right hemithorax relative to its normal position. Dextroversion is the second most common type of dextrocardia3.
Valve surgery for acquired valvular lesions in dextrocardia with situs inversus is also rare. However, there is no study in the literature concerning triple valve surgery and dextrocardia with situs inversus totalis. In this case study, we report on a patient with dextrocardia with situs inversus, illustrating the anatomic issues and operative considerations particular to aortic, mitral and tricuspid valve surgery in patients with this condition.