Arch and frozen elephant trunk repair for aortic dissection in pregnancy with situs inversus totalis.

Acute type A aortic dissection during pregnancy with situs inversus totalis is exceptionally rare. We report a 27-year-old woman at 24 weeks of gestation who underwent emergency ascending aortic and total arch replacement with frozen elephant trunk implantation. Fetal demise occurred on postoperative day 1, but the mother recovered without neurological deficit and remained well at 10-year follow-up. This case demonstrates the feasibility of complex arch repair in mirror-image anatomy and highlights the importance of individualised planning in experienced aortic centres.