A Case of Aortic Valve Implantation by Transcarotid Approach for Aortic Stenosis in Dextrocardia with Situs Inversus

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Severe aortic valve stenosis with situs inversus totalis (n=1). Intervention: Transcarotid transcatheter aortic valve implantation (TC-TAVI). Primary outcome: Procedural success and neurological complications.

Yuki Echie; Hironobu Morimoto; Takashi Harada; Daisuke Futagami; Keijiro Katayama; Katsumasa Sato; Shogo Mukai

doi:10.33290/jtvt.cr.26-0002

January 1, 2026Journal of Transcatheter Valve TherapiesOpen Access

A Case of Aortic Valve Implantation by Transcarotid Approach for Aortic Stenosis in Dextrocardia with Situs Inversus

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Key result

TC-TAVI with horizontal fluoroscopic inversion succeeds safely in a severe AS patient with situs inversus.

n=1

Why the study?

Situs inversus totalis is a rare congenital condition, and TAVI in these patients is technically challenging due to mirror-image anatomy of the heart and great vessels.

Key Points

To describe the procedural strategy and feasibility of transcarotid transcatheter aortic valve implantation combined with fluoroscopic image inversion in a patient with severe aortic stenosis and situs inversus totalis.
Evaluated an 80-year-old male (N=1) with severe symptomatic aortic stenosis, situs inversus totalis, and severe peripheral arterial disease with minimal iliac vessel diameters under 5.5 mm.
Performed transcarotid transcatheter aortic valve implantation from the mid-aortic arch using horizontally inverted fluoroscopy to mirror standard visual views.
The transcarotid valve implantation was completed successfully without procedural or neurological complications.
Direct transcarotid access eliminated the need to traverse the aortic arch or perform 180° delivery catheter rotation in mirror-image cardiovascular anatomy.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

An 80-year-old male with severe symptomatic aortic valve stenosis, situs inversus totalis, and severe peripheral arterial disease making transfemoral access unsuitable.

I

Intervention

Transcarotid transcatheter aortic valve implantation (TC-TAVI) using a 23-mm SAPIEN 3 Ultra Resilia valve, combined with horizontal fluoroscopic image inversion.

O

Outcome

Procedural success and absence of procedural or neurological complications

Transcarotid TAVI combined with horizontal fluoroscopic image inversion is a safe and effective strategy for patients with severe aortic stenosis and mirror-image anatomy (situs inversus totalis) who are unsuitable for transfemoral access.

Limitations

Single case report
Potential risks of the transcarotid approach including stroke and carotid artery complications
Potential stroke risk and carotid artery complications associated with the transcarotid approach

Implication

Viable transcarotid TAVI option for situs inversus without transfemoral access; extends technique in mirror-image anatomy and remains hypothesis-generating.

Abstract

Objective: Situs inversus totalis is a rare congenital condition that may be associated with cardiovascular abnormalities. Transcatheter aortic valve implantation (TAVI) in such patients is technically challenging because of the mirror-image anatomy of the heart and great vessels.

Discussion

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Cite This Study

Echie et al. (2026) conducted a case report in Severe aortic valve stenosis with situs inversus totalis (n=1). Transcarotid transcatheter aortic valve implantation (TC-TAVI) was evaluated on Procedural success and neurological complications. Transcarotid transcatheter aortic valve implantation combined with horizontal fluoroscopic image inversion was safely and successfully performed in a patient with severe aortic stenosis and situs inversus.

synapsesocial.com/papers/69cd7a095652765b073a6dc9 https://doi.org/10.33290/jtvt.cr.26-0002

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A Case of Aortic Valve Implantation by Transcarotid Approach for Aortic Stenosis in Dextrocardia with Situs Inversus

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

A Case of Aortic Valve Implantation by Transcarotid Approach for Aortic Stenosis in Dextrocardia with Situs Inversus

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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