Coronary revascularization in adults with dextrocardia: surgical implications of the anatomic variants

Most reports of coronary artery bypass grafting in adult patients with dextrocardia have focused on the surgeon's position with respect to the operating table. Herein, we describe the cases of 2 patients with dextrocardia who underwent surgery at our own institution, then discuss preoperative evaluation, surgical approaches, and patient outcomes that have been reported in the medical literature. Whereas most patients, including ours, have presented with classic situs inversus totalis and dextrocardia, a few patients have had other associated anomalies or atypical morphologic conditions. Careful imaging, and perhaps cardiac catheterization, is required. Particular attention should be paid to cannulation technique and conduits that can best be used within the altered orientation of the heart. Morbidity rates in these revascularized patients seem comparable with those in coronary artery bypass patients whose coronary anatomy is normal. Anatomic variants in dextrocardia are important from the surgical viewpoint due to the increasing population of patients with repaired congenital heart disease who reach adulthood, and in whom other cardiac defects and abnormalities of cardiac position are common.