Situs inversus totalis describes an anatomical malposition with left-to-right reversal of the viscera combined with dextrocardia. Heart transplantation for situs inversus totalis is surgically challenging, mainly because it requires reconstruction of the mirror-image systemic venous pathways. The patient described was a 44-year-old man with complex congenital heart disease, including situs inversus, dextrocardia, repaired tetralogy of fallot (TOF). Progressive tricuspid regurgitation and right ventricular failure developed in the patient, and he underwent re-do surgery of tricuspid valve repair and pulmonary valve replacement at 40 years of age. Subsequently, however, he developed refractory bi-ventricular failure, oedema, and NYHA class IV dyspnoea (Panel A). We developed a 3D printing model of the aorta, pulmonary artery, vena cave, and heart based on 512-slice cardiac CT angiography to visualize the complex anatomy of heart and formulate a detailed preoperative plan (Panels B, C). He had bilateral superior venae cava (SVC). The recipient left SVC was anastomosed to the donor SVC, and the recipient right SVC was sacrificed. The normal donor heart was rotated 120° to the right to maintain a position of dextrocardia in the recipient. The inferior vena cava (IVC) and main pulmonary artery were anastomosed using Gore-Tex graft conduit to the recipient. The postoperative chest radiograph demonstrated dextrocardia of the transplanted heart (Panel D). The postoperative CT scan shows the IVC and pulmonary artery conduits (Panels E, F). This case illustrates the potentially important role that 3D printed models play in planning and simulating heart transplantation for complex congenital heart disease. (Panel A) Chest X-ray before transplantation. Cardiomegaly with pulmonary oedema. (Panel B) Chest CT image before transplantation. (Panel C) 3D printing model of dextrocardia with repaired TOF. (Panel D) Chest X-ray after transplantation. It demonstrated dextrocardia of the transplanted heart. (Panel E) The postoperative CT scan, anterior view. It shows the IVC and pulmonary artery conduits. (Panel F) The postoperative CT scan, posterior view. AO, aorta; SVC, superior vena cava; IVC, inferior vena cava. *SVC: persistent right SVC.

中文翻译：

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右心室心脏移植：使用3D打印的术前计划。

整体逆转描述了一种解剖学上的错位，内脏从左向右反转，并伴有右旋心动过速。总体位置不全的心脏移植在手术上具有挑战性，主要是因为它需要重建镜像系统性静脉通路。所描述的患者是一名44岁的男性，患有复杂的先天性心脏病，包括眼内翻，右旋心律，修复的法洛四联症（TOF）。患者进展为三尖瓣关闭不全和右心衰竭，他在40岁时接受了三尖瓣修复和肺动脉瓣置换的再次手术。然而，随后，他患上了难治性双室衰竭，水肿和NYHA IV级呼吸困难（图A）。我们开发了主动脉，肺动脉，腔静脉，基于512层心脏CT血管造影术对心脏和心脏进行成像，以可视化心脏的复杂解剖结构并制定详细的术前计划（图B，C）。他有双侧上腔静脉（SVC）。接受者左SVC与供体SVC吻合，并牺牲接受者右SVC。正常的供体心脏向右旋转120°，以在接受者中维持右旋心律的位置。使用Gore-Tex移植导管将下腔静脉（IVC）和主肺动脉吻合。术后胸部X线片显示移植心脏的右旋心动过速（图D）。术后CT扫描显示IVC和肺动脉导管（面板E，F）。该案例说明了3D打印模型在规划和模拟复杂先天性心脏病的心脏移植中可能发挥的潜在重要作用。（图A）移植前的胸部X光片。心脏肥大并伴有肺水肿。（图B）移植前的胸部CT图像。（图C）具有修复过的TOF的右心室3D打印模型。（图D）移植后的胸部X光片。它证明了移植心脏的右旋心动过速。（图E）术后CT扫描，前视图。它显示了IVC和肺动脉导管。（图F）术后CT扫描，后视图。AO，主动脉；SVC，上腔静脉；IVC，下腔静脉。* SVC：永久权限SVC。（图C）具有修复过的TOF的右心室3D打印模型。（图D）移植后的胸部X光片。它证明了移植心脏的右旋心动过速。（图E）术后CT扫描，前视图。它显示了IVC和肺动脉导管。（图F）术后CT扫描，后视图。AO，主动脉；SVC，上腔静脉；IVC，下腔静脉。* SVC：永久权限SVC。（图C）具有修复过的TOF的右心室3D打印模型。（图D）移植后的胸部X光片。它证明了移植心脏的右旋心动过速。（图E）术后CT扫描，前视图。它显示了IVC和肺动脉导管。（图F）术后CT扫描，后视图。AO，主动脉；SVC，上腔静脉；IVC，下腔静脉。* SVC：永久权限SVC。