Anesth Pain Med.  2019 Apr;14(2):193-196. 10.17085/apm.2019.14.2.193.

Anesthetic considerations for a patient with situs inversus totalis undergoing cardiac surgery: A case report

• Koo CH
• Shim JK
• Kim N
• Ki Y
• Park J
• Kim JC

• KMID: 2447968
• DOI: http://doi.org/10.17085/apm.2019.14.2.193

Abstract

A 58-year-old male patient with situs inversus totalis, a rare congenital malformation characterized by all asymmetric organs being formed as the mirror images of their normal morphologies, underwent mitral valve repair due to mitral valve prolapse. This case was reported to suggest that anesthesiologists should thoroughly understand the anatomy of these types of patients before providing cardiac anesthesia that often requires advanced monitoring and rely on their accurate interpretation. Accordingly, a few key points will be discussed with emphasis on reversing lead placement during electrocardiogram monitoring, using the left internal jugular vein for pulmonary artery catheterization, and firmly comprehending mirror image heart morphology to better conduct transesophageal echocardiography.

Keyword

Anesthesia; Situs inversus totalis; Thoracic surgery

MeSH Terms

Anesthesia
Catheterization, Swan-Ganz
Echocardiography, Transesophageal
Electrocardiography
Heart
Humans
Jugular Veins
Male
Middle Aged
Mitral Valve
Mitral Valve Prolapse
Situs Inversus*
Thoracic Surgery*

Figure

• 

  Fig. 1 (A) Echocardiogram with normal lead placement showing right axis deviation. (B) Normal echocardiogram with reverse lead placement. ECG: electrocardiogram.

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  Fig. 2 Anteroposterior chest X-ray on postoperative day 1. Arrows show the right curved shape of pulmonary artery inserted directly via left internal jugular vein without crossing the midline.

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  Fig. 3 (A) Transesophageal echocardiographic midesophageal four chamber view. (B) Transesophageal echocardiographic transgastric short axis view. These views were obtained at angle of 180° (circle). LA: left atrium, LV: left ventricle, RV: right ventricle.

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  Fig. 4 Transesophageal echocardiographic bicaval view obtained at 70° (circle). LA: left atrium, RA: right atrium, SVC: superior vena cava.

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  Fig. 5 Transesophageal echocardiographic aortic valve short-axis view obtained at 140° (circle). AV: aortic valve, LA: left atrium, RA: right atrium, RV: right ventricle.

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