Off-pump total myocardial revascularization for dextrocardia and situs inversus

A 42-year-old man with dextrocardia and situs inversus underwent successful off-pump total myocardial revascularization using the technique popularize d by Tector [Tector 1994, Tector 1996]. The free left internal mammary arte ry (LIMA) was anastomosed to the in-situ right internal mammary artery (RIM A,) at the level of the right-sided left atrial appendage, then anastomosed sequentially to the first diagonal branch (D1) of the left anterior descen ding artery (LAD), and to the LAD. The in-situ RIMA was sequentially anasto mosed to the first and the second obtuse marginal branches (OM1 and OM2) of the circumflex coronary artery. A saphenous vein was then anastomosed to a diffusely diseased posterior descending branch (PDA) of the right coronary artery (RCA). The patient was asymptomatic and in excellent condition thre e months after surgery In economically depressed regions of the world, such as the Gaza Strip, off-pump complete revascularization is an excellent alt ernative to cardiopulmonary bypass.