Cardiac Transplantation in Situs Inversus Totalis: A Surgical Challenge

  • Vanessa Lopes VieiraEmail author
  • Guilherme Henrique Ribeiro de Carvalho
  • Leandro Pedro Goloni Bertollo
  • Fabio Biscegli Jatene
  • Fabio Antonio Gaiotto


A 45-year-old male patient diagnosed with non-compacted right ventricle, situs inversus totalis and dilated cardiomyopathy presented a 6-month report of decompensated heart failure symptoms (fatigue on moderate exertion, dyspnea at rest, and paroxysmal nocturnal dyspnea). As he did not respond to clinical treatment, with dependence on inotropic drugs and a recurrent hospitalization history, he underwent bicaval orthotopic heart transplant with a normal heart donor. The implant was made with ¼ h counterclockwise rotation, bringing the left auricle to medial position and the right chambers to a posterior position (retroaortic superior vena cava and posterior inferior vena cava). The left ventricle was anteriorized; the isotopic pulmonary trunk and the aorta were both in end-to-end anastomosis. The patient evolved well and was discharged on the 28th postoperative day. Ten months after surgery, he was still hemodynamically stable and without any signs of rejection. There are few scientific reports of cardiac transplantation in patients with situs inversus totalis. The greatest difficulty of heart transplant in patients with situs inversus totalis is the reconstruction of the systemic and pulmonary venous pathways. Besides the alignment of the inferior vena cavas, seating the normal donor heart in dextrocardia allows a better accommodation of the organ in the recipient pericardial cavity; it avoids ventricular compression from the three-lobed left lung, which would simulate a tamponade. These were the reasons which led to the choice for this surgical technique in this case.


  1. 1.
    Gonçalves LFG, Souto FMS, Faro FN, Mendonça RC, Oliveira JLM, Sousa ACS. Dextrocardia with situs inversus associated with non-compaction cardiomyopathy. Arq Bras Cardiol. 2013;101(2):e33–6. Scholar
  2. 2.
    Bacal F, Souza-Neto JD, Fiorelli AI, Mejia J, Marcondes-Braga FG, Mangini S, et al. II Diretriz Brasileira de Transplante Cardíaco. Arq Bras Cardiol. 2009;94(1 supl.1):e16–73.Google Scholar
  3. 3.
    Pereira WA. Diretrizes básicas para a captação de múltiplos órgãos da Associação Brasileira de Transplante de Órgãos. São Paulo: ABTO; 2009.Google Scholar
  4. 4.
    Uoc NH, Quan PT. Heart transplant for dextrocardia situs inversus with very complex congenital lesions a challenge of cardiac surgery. Int J Clin Cardiol. 2015;2:049.CrossRefGoogle Scholar
  5. 5.
  6. 6.
    Chang YL, Wei J, Chang CY, Chuang YC, Sue SH. Cardiac transplantation in situs inversus: two cases reports. Transplant Proc. 2008;40(8):2848–51. Scholar
  7. 7.
    Rubay JE, d'Udekem Y, Sluysmans T, Ponlot R, Jacquet L, de Leval MR. Orthotopic heart transplantation in situs inversus. Ann Thorac Surg. 1995;60(2):460–2.CrossRefGoogle Scholar
  8. 8.
    Cooper DK, Ye Y, Chaffin JS, Zuhdi N. A suggested technique for “orthotopic” heart transplantation in a patient with situs inversus. Tex Heart Inst J. 1993;20:281–4.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Doty DB, Renlund DG, Caputo GR, et al. Cardiac transplantation in situs inversus. J Thorac Cardiovasc Surg. 1990;99:493.PubMedGoogle Scholar
  10. 10.
    Deuse T, Reitz BA. Heart transplantation in situs inversus totalis. J Thorac Cardiovasc Surg. 2010;139(2):501–3.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Vanessa Lopes Vieira
    • 1
    Email author
  • Guilherme Henrique Ribeiro de Carvalho
    • 1
  • Leandro Pedro Goloni Bertollo
    • 1
  • Fabio Biscegli Jatene
    • 1
  • Fabio Antonio Gaiotto
    • 1
  1. 1.Faculty of Medicine of University of São Paulo (FMUSP)São PauloBrazil

Personalised recommendations