Mitral valve replacement in a Jehovah's Witness with dextrocardia and situs solitus.

Background And Aims Of The Study: Dextrocardia with situs solitus and mitral valve insufficiency requiring surgical treatment is a rare presentation. Jehovah's Witnesses (JW), a specific religious group, deny any blood transfusion and for this reason the cardiac surgeon has to plan his operation well in advance, particularly in the case of adhesions from previous thoracic procedures.

Materials And Methods: A 50-year-old white female Jehovah's Witness with dextrocardia and situs solitus was referred for surgical treatment of massive mitral valve insufficiency of rheumatic etiology. Due to multiple adhesions from previous bilateral thoracotomies and the inverted position of the heart, cardiopulmonary bypass (CPB) was initiated with an aortic and a left common femoral vein cannulae. CPB was completed with an additional SVC cannula. The surgeon, having excellent exposure from the opposite side of the table, was able to perform a mitral valve replacement (MVR) with a 31 mm St. Jude Medical valve prosthesis, through a giant left atrium under moderate hypothermia and crystalloid cardioplegia. The operation was bloodless, with only two units of autotransfused blood being used with a postoperative hematocrit of 34%.

Results: The patient had an uneventful recovery and has been in NYHA class I for 24 months now.

Conclusions: The case is presented for the safety of the approach, the excellent exposure from the left side in a dextrocardia case and the avoidance of blood transfusion in a Jehovah's patient.