title: Off-pump Y-graft coronary artery bypass in a patient with situs inversus totalis.
abstract: Situs inversus is the mirror image of situs solitus. Situs inversus with dextrocardia is termed 'situs inversus totalis'. Since situs inversus totalis is a rare condition, there are a only a few reports about off-pump coronary artery bypass (OPCAB) in these patients. A 67-year-old man with a diagnosis of situs inversus totalis and three-vessel disease, underwent an elective surgical revascularization. The operation consisted of an OPCAB using a total arterial composite Y-graft. The right internal mammary artery (RIMA) and the left radial artery (RA) were harvested as pedicles and they were anastomized as Y-grafts. Three distal anastomoses were performed: the RIMA to the anterior descending artery and the RA sequentially to the obtuse marginal branch and the posterior descending artery. The peculiarity of OPCAB no-touch with a composite graft in a patient with situs inversus totalis consisted in the mirroring of the whole surgical set-up and of the surgical strategy. The surgery as well as the postoperative period were uneventful. This case report shows the feasibility of OPCAB 'no-touch' with composite arterial grafting in a patient with situs inversus totalis.
authors.affiliation: Thoraxcenter, Medisch Spectrum Twente, Haaksbergerstraat 55, PO Box 50 000, 7500 KA Enschede, The Netherlands. s.arrigoni@mst.nl
authors.forename: Sara Camilla
authors.initials: SC
authors.lastname: Arrigoni
authors.forename: Richard
authors.initials: R
authors.lastname: Oosterhof
authors.forename: Massimo Alessandro
authors.initials: MA
authors.lastname: Mariani
mesh_terms: D000368:Aged; D047549:Coronary Artery Bypass, Off-Pump; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D003914:Dextrocardia / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D008297:Male; D017534:Radial Artery / Q000637:transplantation; D012857:Situs Inversus / Q000150:complications* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome