Triple-vessel percutaneous coronary revascularization in situs inversus dextrocardia

Acute coronary syndrome in Dextrocardia

Situs inversus with dextrocardia is both a clinical and diagnostic challenge for emergency physicians to properly identify acute coronary syndrome. While dextrocardia itself does not independently increase the risk of coronary artery disease, mirrored symptoms, including right-sided and rightward radiating chest pain in any patient with cardiac risk factors should raise suspicion for acute coronary syndrome. In patients with a reversed cardiac silhouette on a chest radiograph, a reversed electrocardiogram, to include both the precordial and limb leads, is necessary to evaluate for cardiac ischemia in presumed dextrocardia. The authors present a case of a 66-year-old man with dextrocardia who presented with shortness of breath and hypotension. Rapid application of a reversed electrocardiogram resulted in the timely diagnosis of ST-segment elevation myocardial infarction and activation of the cardiac catheterization laboratory resulting in the preservation of this patient's life.

Takotsubo Cardiomyopathy in Dextrocardia with Situs Inversus

Takotsubo cardiomyopathy (TTC) is an acute reversible form of left ventricular (LV) systolic dysfunction extending beyond a coronary artery vascular territory usually due to physical or psychological stressors. Dextrocardia with situs inversus is a rare embryologic anomaly whereby the heart and aorta are mirrored on the contralateral side. We describe a case of a 93-year-old female with dextrocardia who presented with chest pain, atrial fibrillation with rapid ventricular response, and transient inferior ST elevation. Coronary angiography demonstrated an eccentric mid right coronary artery (RCA) lesion and apical ballooning consistent with concurrent takotsubo cardiomyopathy (TTC). To our knowledge, this is the first reported case of this dual pathology in a patient with dextrocardia, highlighting the procedural and diagnostic complexity in the setting of a rare anatomicvariant.

Triple vessel percutaneous coronary intervention in a patient with situs inversus dextrocardia using a transradial approach

Situs inversus dextrocardia is a challenging situation for an interventional cardiologist. This report presents a rare case where multivessel percutaneous coronary intervention was performed in a single sitting using transradial approach. The challenges encountered in the procedure and clues to successful outcome are discussed.

Emergent percutaneous coronary intervention for acute myocardial infarction in patients with mirror dextrocardia: case reports and brief review

Mirror-image dextrocardia is a rare congenital abnormality with a life expectancy and risk of myocardial infarction similar to the normal population. Although there have been few case reports of emergent percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) in mirror-image dextrocardia, physicians, especially general and interventional cardiologists encounter problems in the diagnosis and treatment of AMI in these patients. In this paper, we report our experience with two cases of emergent transradial PCI for AMI in patients with the mirror-image dextrocardia. Subsequently, we summarize clinical features, electrocardiograph characteristic, approach to emergent PCI based on a review of the literature.

Successful transradial percutaneous coronary intervention in a patient with dextrocardia and situs inversus

Dextrocardia with situs inversus is a rare clinical entity with an estimated incidence ranges from 1 in 8000 to 1 in10,000. Percutaneous intervention in patient with dextrocardia and situs inversus is clinically challenging due to abnormal orientation of coronary geometry and the intervention requires appropriate use of guiding catheters, engagement technique, appropriate radiological angles as well as views. In this case-report, we describe percutaneous intervention with stenting in 48-year-old male patient with dextrocardia and situs inversus. We successfully deployed drug-eluting stents in right coronary artery and left circumflex artery.