Multivessel Total Arterial Coronary Artery Bypass Grafting in Mesocardia

Mesocardia is an extremely rare congenital cardiac anomaly of counterclockwise rotation of the heart. We report here a case of coronary artery bypass grafting in mesocardia, which has not been described in medical literature. A 52-year-old man had an anterior wall myocardial infarction. Chest roentgenogram, two-dimensional echocardiography, and computed tomography of the chest confirmed mesocardia. Off-pump total arterial revascularization was done. Computed tomography coronary angiography done 1 year after surgery showed all 4 grafts patent. Exposure of aorta and right atrium through the standard median sternotomy is very difficult in mesocardia owing to cardiac rotation and should be kept in mind in this surgery.