The left atrium was accessed via the interatrial groove. A biatrial CMP-IV procedure with mitral valvuloplasty and tricuspid annuloplasty were simultaneously performed ( Supplementary Video 3). The operator operated on the patient's left side while the cardiopulmonary bypass machine was placed on the right side. The cardiopulmonary bypass for the patient was routinely performed via a median sternotomy ( Figure 3A). A 24-h Holter monitoring demonstrated paroxysmal AF with a total burden of 165 min. The left atrium diameter was 5.8 cm without thrombosis formation ( Figures 1E,F and Supplementary Video 1). Transesophageal echocardiography further revealed severe mitral valve regurgitation where the vena contracta was >0.7 cm and tricuspid regurgitation following annular dilation. The anatomic diagnosis was mirror-image dextrocardia, L-loop ventricles, and typical related great arteries without associated congenital cardiac abnormalities ( Figures 1C,D). Chest roentgenogram and computed tomography (CT) showed dextrocardia with an enlarged silhouette and situs inversus totalis ( Figures 1A,B). Physical examination revealed a systolic blowing murmur (grade 3/6) at the fifth intercostal space lateral to the right midclavicular line. The patient, however, had occasional dizziness but denied any history of hypertension or cerebral infarction. He denied any familiar history of situs inversus dextrocardia or other cardiac health comorbidities. Case PresentationĪ 39-year-old man who complained of progressive exertional dyspnea and intermittent palpitation was referred to our department. The case herein is one of the first to report on adopting the CMP-IV procedure for mirror-image dextrocardia patients with complex valvuloplasty operation with the guidance of the 3D printing technique. However, the safety and efficacy of the CMP-IV for situs inversus dextrocardia patients with atrial fibrillation is yet to be determined.
The Cox-Maze IV procedure (CMP-IV) is the only operation and technology with an FDA-approved indication for the surgical treatment of AF. In addition, the 3D printing technique enabled us to practice the Cox-maze IV procedure, given the patient's unique cardiac anatomy. The case herein is one of the first to report on adopting the CMP-IV procedure for situs inversus dextrocardia patients with complex valvuloplasty operation. The patient had an uneventful recovery and was in sinus rhythm during a 12-month follow-up period using a 24-h Holter monitoring device.
Mitral valvuloplasty, CMP-IV, and tricuspid annuloplasty were performed. A three-dimensional (3D) heart model printing device embedded with designated ablation lines was used for pre-operative planning. The patient was diagnosed with situs inversus dextrocardia, severe mitral regurgitation, and paroxysmal atrial fibrillation.
Herein, we present the case of a 39-year-old male patient admitted to our cardiac center following progressive exertional dyspnea. The safety and efficacy of the Cox-Maze IV procedure (CMP-IV) for situs inversus dextrocardia patients with atrial fibrillation is yet to be determined. Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.Long Song †, Chengming Fan †, Hao Zhang, Hongduan Liu, Chukwuemeka Daniel Iroegbu, Cheng Luo and Liming Liu *
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