Right Mini-Thoracotomy for Mitral and Tricuspid Repair in Abdominal Situs Inversus

Heterotaxy with abdominal situs inversus complicates cardiac surgery due to mirror-image anatomy and associated venous anomalies. A 61-year-old woman with heterotaxy, abdominal situs inversus, atrial fibrillation, and prior dual-chamber cardiac pacemaker implantation presented with New York Heart Association class III dyspnea and severe secondary mitral and tricuspid regurgitation. Preoperative imaging revealed a narrow left-sided inferior vena cava and persistent left superior vena cava. Minimally invasive multivalvular repair via right minithoracotomy was successfully performed using dual-site venous drainage. Tailored venous drainage based on detailed preoperative imaging enables safe minimally invasive surgery in patients with complex venous anatomy.