A Rare Case of Dextrocardia with Aortic Root Aneurysm and Coronary Artery Disease Managed with Bentall Procedure and Coronary Artery Bypass Grafting

Abstract

Background: Dextrocardia with situs inversus totalis is a rare congenital condition, and its association with aortic root aneurysm, severe aortic regurgitation, and concomitant coronary artery disease is exceptionally uncommon. Surgical management in such patients is technically demanding due to mirror-image anatomy and altered spatial orientation of the great vessels and coronary arteries. Case Presentation: We report the case of a 51-year-old man with dextrocardia and situs inversus totalis who presented with progressive exertional dyspnea and fatigue over six months. Imaging revealed a markedly dilated aortic root with severe aortic regurgitation and angiographically proven two-vessel coronary artery disease involving the left anterior descending and left circumflex arteries. Transthoracic echocardiography demonstrated left ventricular dilatation with preserved systolic function. Results: The patient underwent an elective Bentall procedure using a mechanical valved conduit with concomitant coronary artery bypass grafting to the left anterior descending artery. Despite the challenges posed by mirror-image anatomy, surgery was completed successfully. The postoperative course was uneventful, with preserved ventricular function, a well-functioning prosthetic valve, and no major complications. The patient was discharged in stable condition on optimal medical and anticoagulation therapy. Conclusion: This case highlights that complex aortic root pathology with associated coronary artery disease can be safely and effectively managed in patients with dextrocardia using a combined Bentall procedure and CABG. Careful preoperative planning and meticulous intraoperative technique are critical to achieving favorable outcomes in such rare anatomical variants.