Arrigoni Sara Camilla, Oosterhof Richard, Mariani Massimo Alessandro
Thoraxcenter, Medisch Spectrum Twente, Haaksbergerstraat 55, PO Box 50 000, 7500 KA Enschede, The Netherlands.
Interact Cardiovasc Thorac Surg. 2010 Dec;11(6):822-4. doi: 10.1510/icvts.2010.244673. Epub 2010 Sep 19.
Situs inversus is the mirror image of situs solitus. Situs inversus with dextrocardia is termed 'situs inversus totalis'. Since situs inversus totalis is a rare condition, there are a only a few reports about off-pump coronary artery bypass (OPCAB) in these patients. A 67-year-old man with a diagnosis of situs inversus totalis and three-vessel disease, underwent an elective surgical revascularization. The operation consisted of an OPCAB using a total arterial composite Y-graft. The right internal mammary artery (RIMA) and the left radial artery (RA) were harvested as pedicles and they were anastomized as Y-grafts. Three distal anastomoses were performed: the RIMA to the anterior descending artery and the RA sequentially to the obtuse marginal branch and the posterior descending artery. The peculiarity of OPCAB no-touch with a composite graft in a patient with situs inversus totalis consisted in the mirroring of the whole surgical set-up and of the surgical strategy. The surgery as well as the postoperative period were uneventful. This case report shows the feasibility of OPCAB 'no-touch' with composite arterial grafting in a patient with situs inversus totalis.
内脏反位是正常内脏位置的镜像。伴有右位心的内脏反位称为“完全性内脏反位”。由于完全性内脏反位是一种罕见的情况，关于这些患者非体外循环冠状动脉搭桥术（OPCAB）的报道仅有少数几例。一名67岁诊断为完全性内脏反位且患有三支血管病变的男性接受了择期手术血运重建。手术采用全动脉复合Y形移植物进行非体外循环冠状动脉搭桥术。取右侧乳内动脉（RIMA）和左侧桡动脉（RA）作为蒂，并将它们吻合为Y形移植物。进行了三处远端吻合：RIMA与前降支动脉吻合，RA依次与钝缘支和后降支动脉吻合。在完全性内脏反位患者中使用复合移植物进行非体外循环冠状动脉搭桥术的“非接触”特点在于整个手术设置和手术策略的镜像操作。手术及术后过程均顺利。本病例报告显示了在完全性内脏反位患者中使用复合动脉移植物进行非体外循环冠状动脉搭桥术“非接触”操作的可行性。
