Just flip it!—CRT implantation in a patient with dextrocardia and situs inversus totalis

Implantation of a cardiac resynchronization therapy (CRT) device in patients with congenital heart disease may be challenging because of the particular underlying anatomy. We present the case of a right‐sided transvenous implantation of a dual‐chamber CRT‐D device in a patient with situs inversus totalis and mirror image dextrocardia. To facilitate our anatomic orientation and to overcome unusual hand‐eye coordination problems, we decided to flip the fluoroscopic image projection by 180° (right‐left), creating the optical impression of a “normalized” heart position (levocardia). This simple approach allowed us to successfully implant the device using a conventional left‐sided CRT delivery system.