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  • Meeting abstract
  • Open Access

Left atrial myxoma in dextrocardia with situs inversus totalis

  • 1 and
  • 2
Journal of Cardiothoracic Surgery201510 (Suppl 1) :A104

https://doi.org/10.1186/1749-8090-10-S1-A104

  • Published:

Keywords

  • Situs Inversus
  • Total Hysterectomy
  • Atrial Myxoma
  • Valve Orifice
  • Dextrocardia

Background/Introduction

We present the rare case of a 69-year-old female, with a history of dextrocardia with situs inversus totalis presenting to her general practitioner with a six-month history of shortness of breath on exertion and pre-syncope. The patient was diagnosed with dextrocardia at age 10, and situs inversus incidentally on total hysterectomy at age 42.

Aims/Objectives

To report and show video of this rare case of left atrial myxoma in dextrocardia with situs inversus totalis and highlight the diagnostic and ergonomic considerations necessary for the optimal operative management of this condition.

Method

Echocardiography demonstrated a mass consistent with left atrial myxoma obstructing the mitral valve orifice. CT angiography confirmed true situs inversus with right-sided aortic arch, dextrocardia, left-sided SVC and IVC, right-sided descending thoracic aorta, left-sided liver and right-sided spleen. A 65 × 38 × 34 mm mass arising from inter-atrial septum was visualised extending into the LV.

Coronary anatomy showed no significant lesions.

A trans-septal approach was used, with reconstruction of the inter-atrial septum. The surgeon performed the operation from the contralateral side to facilitate vision and exposure. The septum was initially inadvertently incised too anterior gaining access to the aorta. This was easily repaired and a second more posterior incision gained access into the left atrium.

Results

Surgery was successful, with post-op TOE showing intact septum and AV-valve. Histopathological analysis confirmed the diagnosis. The patient was transferred to HDU. Fast AF Day 1 post-surgery was treated successfully with DCCV and she was discharged on day 10. At 2 month follow-up, she was well and asymptomatic.

Discussion/Conclusion

Operating on left atrial myxoma in dextrocardia with situs inversus presents a unique operative challenge, requiring briefing the entire operating team of the planned approach, and remaining mindful of the ergonomics of theatre. Cardiac theatre by nature is highly consistent in the set-up for routine cases. In such a case, positioning of the surgeon, assistants and perfusionist is altered. Usual anatomical landmarks and topography are distorted, facilitating inadvertent entry into the incorrect chamber. Good planning and briefing are essential for optimal technique and patient outcomes.

Consent

Authors’ Affiliations

(1)
Brighton and Sussex Medical School, University of Sussex, East Sussex, BN1 9PX, UK
(2)
Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton, East Sussex, BN2 5BE, UK

Copyright

© Gabriel and Ahmed 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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