Multivalvular rheumatic heart disease in a case of dextrocardia with situs inversus: an arduous surgical access

Dextrocardia is a rare congenital cardiac anomaly where the base-apex axis of the heart is directed to right side. Incidence of dextrocardia is 1 in 10,000 live births, and it may be associated with other congenital cardiac diseases. In cases of dextrocardia, the atrial situs can be situs solitus, situs inversus, or situs ambiguous of which dextrocardia with situs inversus (mirror image dextrocardia) is more common (40%). If all the visceral organs also get mirrored, then it is called dextrocardia with situs inversus totalis. Though dextrocardia can be associated with other congenital cardiac anomalies, its association with rheumatic heart disease is extremely rare. We report a case of dextrocardia with rheumatic heart disease involving the mitral and tricuspid valves.