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Updated: Apr 25, 2026
Cox-Maze IV Procedure Concomitant with Valvular Surgery In Situs Inversus Dextrocardia: A Single-Center Experience in China
Published on: February 11, 2022
[Maze procedure in a case of dextrocardia with atrial septal defect and persistent left superior vena cava]
Arata Muraoka1, Masaaki Kawada, Yoshio Misawa
1Division of Cardiovascular Surgery, Jichi Medical University, Tochigi, Japan.
Insights
This study details the successful surgical repair of atrial fibrillation in a patient with dextrocardia, atrial septal defect, and persistent left superior vena cava. The patient maintained normal sinus rhythm post-operation, highlighting effective intracardiac repair techniques.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Cardiac Surgery
Context:
- Dextrocardia is a rare congenital condition where the heart is on the right side of the chest.
- Atrial fibrillation (AF) management in patients with complex congenital heart disease presents unique challenges.
- This case involves a 52-year-old male with a history of dextrocardia since infancy, presenting with new-onset atrial fibrillation.
Purpose:
- To describe the successful surgical management of atrial fibrillation in a patient with dextrocardia and associated cardiac anomalies.
- To illustrate the technical aspects of cardiopulmonary bypass and intracardiac repair in the presence of a persistent left superior vena cava.
- To report the long-term postoperative outcome regarding rhythm control.
Summary:
- A 52-year-old man with dextrocardia, atrial septal defect, tricuspid regurgitation, and a persistent left superior vena cava underwent intracardiac repair for atrial fibrillation.
- The procedure included tricuspid annuloplasty and a maze procedure, with cardiopulmonary bypass established via the inferior vena cava, persistent left superior vena cava, and direct cannulation of the small superior vena cava.
- Postoperative recovery was uneventful, with sustained normal sinus rhythm observed for 3.5 years.
Impact:
- Demonstrates the feasibility and efficacy of complex intracardiac repair for atrial fibrillation in patients with dextrocardia.
- Provides valuable insights into surgical strategies for managing venous anomalies during cardiac procedures.
- Highlights the potential for long-term rhythm stability after surgical intervention in this complex patient population.
Abstract:
A 52-year-old man was diagnosed with dextrocardia at the age of 1 year and was asymptomatic until 1 year before admission. He was transferred to our hospital for management of atrial fibrillation. A transthoracic echocardiogram showed dextrocardia with atrial septal defect;moderate tricuspid valve regurgitation; and a large, persistent left superior vena cava. A cardiac catheterization study revealed that pulmonary flow/systemic flow (Qp/Qs) was 3.6 and that pulmonary vascular resistance was 2.5 Wood U·m². Intracardiac repair with tricuspid annuloplasty and a maze procedure was scheduled. When establishing cardiopulmonary bypass, venous drainage was initially obtained from the inferior vena cava and the left superior vena cava, and the small superior vena cava was then directly cannulated after opening the right atrium. The patient's postoperative course was uneventful, and serial electrocardiograms have demonstrated maintenance of normal sinus rhythm for 3.5 years after the operation.
