Mitral valve replacement via a left thoracotomy in dextrocardia and situs solitus.

Dextrocardia with situs solitus and severe mitral regurgitation is a rare clinical presentation which posse a surgical challenge and requires specific preoperative planning. A 54-year-old women with this anatomy, multiple thoracic procedures, and severe mitral valve regurgitation underwent successful mitral valve replacement with a 27-mm mechanical prosthesis through a left thoracotomy under ventricular fibrillation, on the basis of computed tomography findings. We emphasize the importance of preoperative planning and a surgical approach through a left thoracotomy and under ventricular fibrillation.

Method to calculate the protamine dose necessary for reversal of heparin as a function of activated clotting time in patients undergoing cardiac surgery.

Activated clotting time (ACT) has been used to monitor coagulation and guide management of anticoagulation control in patients undergoing cardiac surgery for decades. However, reversal of heparin with protamine is typically empirically based on total heparin administered. Dose-related adverse effects of protamine are well described.