Coronary Artery Bypass Surgery in a Patient with Situs Inversus

Irvin, Robert G.; Ballenger, James F.

doi:10.1378/chest.81.3.380

Cited by 32 publications

(18 citation statements)

References 6 publications

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“…5,6,7 Others have used saphenous vein as graft. 8,9 The long patency of arterial graft is well established, so we used internal mammary artery to bypass LAD. In dextrocardia, use of left IMA would raise the issue of inappropriate length and of crossing the midline.…”

Section: Discussion Of Managementmentioning

confidence: 99%

Coronary Artery Bypass in Dextrocardia

Jaiswal¹,

Hote²

2017

jemds

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Section: Discussion Of Managementmentioning

confidence: 99%

Coronary Artery Bypass in Dextrocardia

Jaiswal¹,

Hote²

2017

jemds

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“…Hence, even elderly patients with this rare anomaly have been subjected to successful percutaneous or surgical intervention of CAD, as reported in literatures [5,6]. The first cardiac catheterization in dextrocardia was reported in 1973 [7], the first coronary artertery bypass surgery in 1980 [8] and the first percutaneous intervention in dextrocardia performed in 1987 [9].…”

Section: Discussionmentioning

confidence: 99%

Trans-Radial Percutaneous Coronary Intervention in Dextrocardia: Case Report and Review of Literature

El-Hosieny¹

2014

JCCR

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of 5 Fr JL 3.5 guide catheter and a 0.014" balanced middleweight (BMW) guide wire. Two overlapping drug-eluting stents (Xience Prime 2.5x28 mm and Promus Element 2.25x12 mm) were directly deployed at the site of the lesion in the middle segment of the LAD artery with good angiographic result (Figure 4). The patient experienced an uneventful post-PCI course and was discharged on the following day. He was free of angina on clinical follow-up. DiscussionDextrocardia refers to the position of the heart in the right side of the chest. It is a rare clinical phenomenon with a reported incidence of 1 in 5,000-30,000 [1]. In the absence of other structural heart disease, the life expectancy is usually normal. The association of coronary artery disease (CAD) in these patients is the same as in the general population [4]. Hence, even elderly patients with this rare anomaly have been subjected to successful percutaneous or surgical intervention of CAD, as reported in literatures [5,6]. The first cardiac catheterization in dextrocardia was reported in 1973 [7], the first coronary artertery bypass surgery in 1980 [8] and the first percutaneous intervention in dextrocardia performed in 1987 [9].Presentation of patients with dextrocardia with variant myocardial ischemia symptoms of right-sided chest pain has been previously noted [10][11][12]. The reason for this atypical presentation is unclear. Situs inversus has been previously shown to be associated with abnormal neural axis development [13] and this may lead to variant visceral pain presentation. Afferent fibers from the heart traveling along the sympathetic trunks of the neck and thorax may enter the higher thoracic levels (T1 to T4/5) from the right rather than the left side, thus associating with spinal ganglia and spinal cord segments receiving sensory impulses from the right side of the body. This may also explain previous reports of ischemic pain referral down the right shoulder and arm in these patients [7,14,15]. Pain localization from abdominal viscera is also discrepant and suggests that peripheral nerve route transposition occurs in about 50% of cases of situs inversus. Consequently, patients with dextrocardia may present with pain referred to either the left or the right side of the body [16].Moreyra et al. [9] who first reported a case of percutaneous transluminal coronary angioplasty in dextrocardia with situs inversus, found Judkins catheters unhelpful and advocated using multipurpose catheters because their flexible tips allowed for easy manipulation into the coronary ostia. It has since been suggested that the suitability of diagnostic and interventional guide catheters can be predicted by the aortic arch position [17][18][19]. In our experience, however, even in the presence of right-sided aortic arch, the left Judkins catheter can be used to cannulate the right-sided morphologically left coronary artery. Similarly, the right Judkins catheter manipulated to the mirror of its usual position can cannulate the left-sided morphological RCA. Notably, cathe...

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“…There have been a few reports of myocardial revascularization in dextrocardiac patients with cardiopulmonary bypass. [1][2][3][4][5][6][7]9,10,14,15 However, off-pump coronary artery bypass (OPCAB) has been performed in only six patients (Table 1). 8,[11][12][13]16 In this case, the in situ left ITA was anastomosed to the LAD, and the in situ right ITA was anastomosed to the high lateral branch.…”

Section: Discussionmentioning

confidence: 99%

Off-pump coronary artery bypass grafting in an octogenarian with situs inversus and dextrocardia: Report of a case

et al. 2011

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Dextrocardia associated with situs inversus totalis is a rare condition. A small number of patients with the condition have been reported after undergoing myocardial revascularization. We experienced a case of this rare disorder in an 83-year-old man. He was successfully treated by off-pump coronary artery bypass grafting with bilateral internal thoracic arteries and a saphenous vein. Except for the mirror-image anatomy, the surgical technique was similar to that used for a patient with situs solitus.

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Coronary Artery Bypass Surgery in a Patient with Situs Inversus

Cited by 32 publications

References 6 publications

Coronary Artery Bypass in Dextrocardia

Coronary Artery Bypass in Dextrocardia

Trans-Radial Percutaneous Coronary Intervention in Dextrocardia: Case Report and Review of Literature

Off-pump coronary artery bypass grafting in an octogenarian with situs inversus and dextrocardia: Report of a case

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