Anaesthetic challenges in staged repair of coarctation and severe aortic stenosis in dextrocardia with situs inversus

Coarctation of the aorta (CoA) is a rare congenital anomaly which can remain undiagnosed into adulthood. Furthermore, additional congenital anomalies of dextrocardia and situs inversus pose significant diagnostic and perioperative challenges and are exceedingly rare in occurrence. We report a unique case of a 53-year-old male with bicuspid aortic valve, severe aortic stenosis, ascending aortic aneurysm and post-ductal CoA, along with dextrocardia and situs inversus. He underwent staged surgical correction: first, CoA repair via right posterolateral thoracotomy due to dextrocardia; followed by a modified Bentall procedure five months later. Anaesthetic management required tailored planning, modified monitoring and careful interpretation of standard investigations like ECG and transoesophageal echocardiography. Multidisciplinary collaboration enabled successful outcomes in this complex setting.