A 70-year-old man with dextrocardia with situs inversus, presented to our hospital complaining of chest pain. ECG showed ST elevations in leads II, III and _aV_f , and ST depressions in leads V3 through V6. Blood tests showed creatinine kinase elevation. He underwent coronary angiography, which revealed obstruction of the anatomical right coronary artery and we diagnosed acute inferior myocardial infarction. However, the anatomical left coronary artery was not clearly identifiable because of its anomalous origin. He was transferred to our intensive care unit and intra-aortic balloon pumping was initiated. Coronary 3D-CT was then performed to obtain an anatomical overview of the coronary artery system. This enabled a second coronary angiography which showed obstruction of the left anterior descending artery and stenosis of the left main trunk in the first diagonal branch and the ramus intermedius branch. Coronary artery bypass grafting surgery (CABG) was indicated. He underwent conventional quintuple CABG using the right internal thoracic artery and saphenous vein grafts. Preoperatively we made digital mirror images of the original coronary angiographic images to clarify his coronary artery anatomy. During surgery, the main surgeon continuously stood on the patient's left side except when opening and closing the chest, which enabled us to perform CABG. The postoperative course was uneventful. CABG in a patient with situs inversus totalis is very rare. We present this case with a review of the relevant literature.

Recently, there have been some reports that cone reconstruction can be performed in the repair of Ebstein's anomaly with acceptable result on a child. On an adult with Ebstein's anomaly, optimal surgical indication and choice of the operative procedure are controversial. A man in his seventies was diagnosed with Ebstein's anomaly incidentally during preoperative examination of severe aortic regurgitation. We performed aortic valve replacement and cone reconstruction, because his tricuspid regurgitation was moderate. There was no severe complication and he was discharged. No sign of recurrence have been observed after 4 months follow up. We present a case in which cone reconstruction and aortic valve replacement were successfully performed on an adult patient diagnosed with Ebstein's anomaly and severe aortic regurgitation.