Mitro-aortic subacute bacterial endocarditis in a patient with situs inversus totalis

Abstract

Introduction: Situs inversus is a genetic disorder in which the main organs are in reversed position inside the human body (mirror image). The situation in which the heart is positioned on the right side of the thorax is known as situs inversus with dextrocardia or situs inversus totalis. If the heart remains on the normal left side of the thorax, we can speak about a much rarer condition (1 in 22.000 of the general population) known as situs inversus with levocardia or situs inversus incompletus. Material and Methods: In this paper we refer to a 42 years old patient with situs inversus totalis and cardiovascular pathology due to subacute bacterial endocarditis of the aortic valve complicated with the perforation of the anterior cusp of mitral valve associated with severe aortic regurgitation and moderate mitral regurgitation, NYHA class IV heart failure admitted in IBCV "Prof Dr. George I. M. Georgescu" Iaşi for dyspnea at rest, fatigue, swelling of the lower limbs, cough. Preoperative invasive and noninvasive examination revealed multiple cardiovascular injuries. The surgical approach was aortic valve replacement with mechanical prosthesis and reconstruction of the anterior leaflet of the mitral valve with autologous pericardial patch. Results: The post-operatory evolution was favorable and the control echocardiography showed normofunctional aortic valve prosthesis and normal cooptation of the mitral valve leaflets with no signs of cardiac decompensation. Conclusion: Dextrocardia is a rarely seen cardiac malposition, often associated with multiple and complex congenital cardiac anomalies. Valve surgery for acquired valvular lesions in dextrocardia with situs inversus is also rare. Surgeons require a prospective strategy for handling problems such as poor exposure of the cannulation site and diseased valve. The case illustrates the anatomic issues and operative considerations particular to aortic and mitral valve surgery in patients with this condition.