Magnetic resonance imaging of acute myocardial infarction in dextrocardia with situs solitus (dextroversion)

Triple-vessel percutaneous coronary revascularization in situs inversus dextrocardia

Dextrocardia with situs inversus occurs in approximately one in 10,000 individuals of whom 20% have primary ciliary dyskinesia inherited as an autosomal recessive trait. These patients have a high incidence of congenital cardiac disease but their risk of coronary artery disease is similar to that of the general population. We report what is, to our knowledge, the first case of total triple-vessel coronary revascularization by percutaneous stent implantation in a 79-year-old woman with situs inversus dextrocardia. We describe the successful use of standard diagnostic and interventional guide catheters with counter rotation and transversely inversed image acquisition techniques. The case also highlights that the right precordial pain may represent cardiac ischemia in this population.

Approach to Dextrocardia in Adults:Review

OBJECTIVE

The educational objectives of this article are to describe an approach to analyzing imaging studies in adults with dextrocardia and to present the appearances of the most common underlying disorders. Topics reviewed include the morphology of the cardiac chambers, the concept of situs, and the relevant embryologic principles. The disorders discussed include situs inversus totalis (mirror-image dextrocardia), dextroversion, congenitally corrected transposition of the great arteries, and polysplenia syndrome.

CONCLUSION

In this article we describe an approach to dextrocardia in adult patients and illustrate the imaging manifestations of the most common underlying disorders.

Percutaneous coronary intervention in a patient with cardiac dextroversion

Dextrocardia associated with atrial situs solitus is commonly referred to as dextroversion. Dextroversion is a result of early interruption of normal embryological development and, therefore, rarely occurs without other associated cardiac and noncardiac anomalies. While percutaneous coronary intervention has been described in many cases of dextrocardia with situs inversus, it has not been previously described in dextroversion. We report the case of an 88-year-old woman with dextroversion who presented with an acute anterior myocardial infarction that was successfully treated with coronary stent implantation.

CT Appearance of Isolated Dextroversion

We present the multidetector CT appearance of a case of isolated dextroversion. Dextroversion is a rare anomaly characterized by extreme right-sided rotation of the heart resulting in dextrocardia with the left ventricle anterior and to the left of the right ventricle. The diagnosis is easily made with ECG-gated multidetector CT.