CASE REPORTS   

Chirurgia 2015 October;28(5):197-9

Copyright © 2015 EDIZIONI MINERVA MEDICA

language: English

Mitral valve surgery for infective endocarditis in a patient with situs inversus totalis

Navez J., Cheron P., Guennaoui T., Van Ruyssevelt P.

Cardiac Surgery Unit, Jolimont Hospital, Haine-Saint-Paul, Belgium

Situs inversus totalis (SIT) is a rare congenital anomaly characterized by thoracic and abdominal organs positioned in a mirror image of their normal position. Numerous cases of cardiac surgery have been reported, mostly about myocardial revascularization, rarely about valvular surgery. This is the first case report on surgical treatment of endocarditis in such a patient. We describe the case of a 45-year old woman with infective mitral endocarditis, diagnosed by arterial digital thrombosis, who underwent a prosthetic replacement after complete debridement. Blood cultures were positive for a multisensible Streptococcus anginosus. For cardiac surgery, SIT creates diagnostic and surgical difficulties that arise from this position of the organs. Complete preoperative assessment including thoraco-abdominal computed tomodensitometry and endoscopic echocardiography is essential to exclude other anomalies and define perfectly the atypical anatomy. A specific attention is required for the usual maneuvers due to anatomical irregularities and orientations.