Case Report: Off-Pump Total Myocardial Revascularization for Dextrocardia and Situs Inversus

(#2001-30488 ... July 16, 2001)

Imad F. Tabry, MD,¹ James Calabrese, MD, ¹ Hassan Zammar, MD, ² Kamel AbouKasem, MD, ² Housny Akeilan, MD, ² Nahed Gharbieh, MD, ² Hisham Zinati, MD, ² Wael Noureddine, MD, ² Atef elHout, MD, ² Mosbah Tayah, MD, ² Lu'ay Khalidy, MD, ² Marwan Yaghi, MD²

Sections of Cardiac Surgery, Cardiology, and Anesthesiology, ¹Holy Cross Hospital, Fort Lauderdale, FL, and ²Al Shifa Hospital (Gaza Strip)

ABSTRACT

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.

AUTHOR/ARTICLE INFORMATION

Acknowledgments

Our mission to Gaza would not have been possible without the unselfish involvement of Joan Barbati, RN, CCRN, Layna Harper, RN, CCRN, Nestor Megano, CPP, Teresa Miller, RN, and MariNoel Weatherly, RN. Their willingness to volunteer their time and expertise, and the gratitude we encountered on the part of the patients we operated upon and the local cardiac surgical team, far outweighed the gravity of the political situation and the violent confrontations our visiting team found itself in the midst of during our mission.