Totally endoscopic mitral valve repair in situs inversus totalis: how to do it

Background: Situs inversus totalis (SIT) is a rare congenital condition characterized by complete mirror-image transposition of thoracic and abdominal organs. When combined with dextrocardia, it poses significant anatomical and ergonomic challenges for cardiac surgery, particularly for minimally invasive approaches. Case Presentation: A 68-year-old female was admitted to our hospital with dyspnea on exertion. Chest X-ray and chest computerized tomography (CT) confirmed SIT without venous anomalies. Transthoracic echocardiography demonstrated severe mitral valve regurgitation caused by rupture of the chordae posterior leaflet. The patient underwent totally endoscopic mitral valve repair through a left mini-thoracotomy, with implantation of a size 28 Carpentier annuloplasty ring. Discussion: Totally endoscopic surgery allows for enhanced visualization and a broader operative field when approaching the mitral valve through a left mini-thoracotomy. The success of the procedure largely depends on the experience and technical expertise of the surgical team. The challenges in surgery include reversed visual orientation and hand movements compared to normal. Conclusion: Totally endoscopic mitral valve repair in SIT is feasible and safe procedure.