Transcatheter Aortic Valve Replacement in a Patient With Dextrocardia and Situs Inversus Totalis Gregory Pattakos, MD, MS, Michael Chrissoheris, MD,

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Transcatheter Aortic Valve Replacement in a Patient With Dextrocardia and Situs Inversus Totalis Gregory Pattakos, MD, MS, Michael Chrissoheris, MD, Antonios Halapas, MD, Konstantinos Papadopoulos, MD, Panagiota Kourkoveli, MD, Nikolaos Bouboulis, MD, PhD, Stratis Pattakos, MD, PhD, Konstantinos Spargias, MD, PhD The Annals of Thoracic Surgery Volume 107, Issue 1, Pages e33-e35 (January 2019) DOI: 10.1016/j.athoracsur.2018.05.041 Copyright © 2019 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Computed tomography scan of patient with situs inversus shows (A) right-sided aortic arch and (B) dextrocardia. The Annals of Thoracic Surgery 2019 107, e33-e35DOI: (10.1016/j.athoracsur.2018.05.041) Copyright © 2019 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 The transcatheter delivery device was rotated 180 degrees to facilitate placement. (A) Typical orientation for use in patients with normal anatomy. (B) Catheter rotated to facilitate delivery in the patient with right-sided aortic arch and dextrocardia. The Annals of Thoracic Surgery 2019 107, e33-e35DOI: (10.1016/j.athoracsur.2018.05.041) Copyright © 2019 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Mirror-image rotation achieved with fluoroscopy software. (A) Regular view shows temporary pacemaker in the right ventricle and pigtail in the aortic root. (B) View at the time of implantation is facilitated by mirror-image inversion of the fluoroscopy image by software. The Annals of Thoracic Surgery 2019 107, e33-e35DOI: (10.1016/j.athoracsur.2018.05.041) Copyright © 2019 The Society of Thoracic Surgeons Terms and Conditions