Off-Pump Coronary Artery Bypass Surgery in Dextrocardia: A Report of Two Cases

Dextrocardia is a rare condition that may be congenital (situs inversus) or aquired (pseudodextrocardia). Since individuals with this ailment have normal cardiac physiology and function, they may live normal lives. Similar to the general population, however, they might be susceptible to ischemic heart disease and present to a cardiothoracic surgical department for coronary artery bypass surgery. We report two cases: one of dextrocardia (situs inversus) and another resulting from an elevation of the left hemidiaphragm, causing pseudodextrocardia. To operate on patients with dextrocardia, surgeons may need to make a few modifications. These include using the right internal mammary artery as a conduit for the "left" anterior descending artery, lengthening the left internal mammary artery to reach the left anterior descending artery, and sometimes the operating surgeon may need to stand at the left side of the operating table. The careful planning of work on the conduits in the preoperative period requires prudence. This report highlights the surgical difficulties during operations on patients with situs inversus or pseudodextrocardia. (Ann Thorac Cardiovasc Surg 2008; 14: 187-191)