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A 26-year-old patient with mirror-image dextrocardia and situs inversus experienced a transient ischemic attack. We suspected that a patent foramen ovale was the reason. A Cardi-O-Fix occluder was used to close the patent foramen ovale with a mirror-reversed rotation of the radiologic views. During the 18-month follow-up, no symptoms of the transient ischemic attack appeared again.