Transfemoral aortic valve implantation using the reverse X-ray image in a patient with dextrocardia situs inversus

A frail 94-year-old man, who had dextrocardia situs inversus and symptomatic severe aortic stenosis, underwent transcatheter aortic valve implantation (TAVI) using the femoral approach. Computed tomography showed that there were no other cardiovascular malformations. Generally, it was difficult to maintain awareness of the position between his heart and ascending aorta during the procedure because of the inversion of these structures. Therefore, the reverse X-ray image was used to facilitate TAVI, and the procedure was successful without complications. However, nine days after TAVI, he developed complete atrioventricular block that was symptomatic. Therefore, he underwent cardiac pacemaker implantation using the reverse X-ray image to help position the atrial and ventricular leads.