Left-sided surgical approach for tricuspid valve replacement in congenitally corrected transposition of the great arteries with dextrocardia and situs inversus totalis: A case report

Congenitally corrected transposition of the great arteries (ccTGA) is a rare congenital cardiac anomaly characterized by atrioventricular and ventriculoarterial discordance, resulting in a physiologically corrected circulation. When ccTGA is combined with dextrocardia and situs inversus totalis, surgical management becomes particularly challenging because of the mirror-image anatomy and altered spatial orientation. A 61-year-old man presented with progressive dyspnea and was diagnosed with ccTGA accompanied by dextrocardia and situs inversus totalis. Transthoracic echocardiography revealed severe regurgitation of the systemic atrioventricular valve (morphological tricuspid valve) with dilation and systolic dysfunction of the systemic right ventricle. Comprehensive preoperative imaging confirmed atrioventricular and ventriculoarterial discordance, right-sided cardiac apex, and complete visceral inversion. Tricuspid valve replacement was performed via a median sternotomy with the surgeon standing on the patient’s left side to accommodate the mirror-image anatomy. Cardiopulmonary bypass was established safely after meticulous identification of the great vessels. A mechanical prosthetic valve was successfully implanted. The postoperative course was uneventful, and follow-up echocardiography at six months confirmed satisfactory prosthetic valve function without complications. This case illustrates that tricuspid valve replacement can be safely and effectively performed in patients with ccTGA complicated by dextrocardia and situs inversus totalis. A left-sided surgical approach, combined with thorough preoperative imaging and careful intraoperative anatomical verification, may help restore operative orientation and reduce technical complexity in patients with mirror-image cardiac anatomy.