TAVI for severe AS in a patient with dextrocardia, situs inversus, horizontal aorta, bicuspid valve, and ascending aortic aneurysm
The patient was a 70-year-old male diagnosed with dextrocardia and situs inversus totalis. He had undergone pacemaker (PM) implantation for sick sinus syndrome (SSS) 20 years ago and percutaneous coronary intervention for left anterior descending coronary artery stenosis 15 years ago. Several years ago, he developed dyspnea on exertion, and a detailed examination revealed severe aortic valve stenosis (AS). The patient’s symptoms gradually worsened, leading to the decision to proceed with surgery. Although he was relatively young, his activity levels were reduced due to the aftereffects of a traffic accident. Therefore, we opted for transfemoral transcatheter aortic valve implantation (TAVI) using a balloon-expandable aortic valve. Given the patient’s complex anatomy, including dextrocardia, situs inversus, an ascending aortic aneurysm, and a Type 0 bicuspid valve with a horizontal aorta, TAVI was performed with particular caution. Owing to the dextrocardia in the patient, the monitor display was inverted during surgery to facilitate prosthetic valve deployment, and the procedure was completed without any complications. The patient had a good postoperative course and was discharged on postoperative day 9. This is a rare case of TAVI performed for AS in a patient with dextrocardia and situs inversus totalis. By inverting the monitor display during prosthetic valve deployment, the procedure was conducted using the same visual orientation as in a typical case, simplifying the operation.
