Case report: off-pump total myocardial revascularization for dextrocardia and situs inversus

A 42-year-old man with dextrocardia and situs inversus underwent successful off-pump total myocardial revascularization using the technique popularized by Tector [Tector 1994, Tector 1996]. The free left internal mammary artery (LIMA) was anastomosed to the in-situ right internal mammary artery (RIMA) at the level of the right-sided left atrial appendage, then anastomosed sequentially to the first diagonal branch (D1) of the left anterior descending artery (LAD), and to the LAD. The in-situ RIMA was sequentially anastomosed to the first and the second obtuse marginal branches (OM1 and OM2) of the circumflex coronary artery. A saphenous vein was then anastomosed to a diffusely diseased posterior descending branch (PDA) of the right coronary artery (RCA). The patient was asymptomatic and in excellent condition three months after surgery. In economically depressed regions of the world, such as the Gaza Strip, off-pump complete revascularization is an excellent alternative to cardiopulmonary bypass.