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Tex Heart Inst J. 2010; 37(6): 734–735.
PMCID: PMC3014116

Repeat Right Transradial Intervention in 9 Days in a Patient with Dextrocardia and Situs Inversus

Zi-Wen Zhao, MD, Chao-Gui Lin, MD, and Liang-Long Chen, MD, FACC
Raymond F. Stainback, MD, Section Editor
Department of Adult Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, 6624 Fannin St., Suite 2480, Houston, TX 77030

A 72-year-old man presented with a 1-day history of intermittent retrosternal and right anterior chest tightness that radiated to the right shoulder and forearm. Physical examination produced findings that were consistent with dextrocardia and situs inversus. Chest radiographs revealed dextrocardia with a right-sided aortic knob. Echocardiograms showed dextrocardia without concomitant congenital disease.

Transradial coronary angiography was performed. The left angiogram showed a 50% stenosis at the ostium of the left circumflex coronary artery (LCx) and an 85% stenosis at the mid LCx (Fig. 1). The right angiogram revealed a large right coronary artery with a nearly 80% proximal stenosis (Fig. 2). Right transradial percutaneous coronary intervention (PCI) to the LCx was performed. The implantation of a 3.5 × 23-mm YINYI™ polymer-free paclitaxel-eluting stent (Dalian Yinyi Biomaterials Development Co., Ltd.; Dalian, PRC) resulted in Thrombolysis In Myocardial Infarction (TIMI) III flow (Fig. 3). Nine days later, repeat right transradial PCI was performed, and a 5 × 16-mm Taxus® paclitaxel-eluting stent (Boston Scientific Corporation; Natick, Mass) was implanted in the proximal right coronary artery. Angiograms subsequently revealed no residual stenosis or stent malapposition (Fig. 4). Both interventional procedures were performed with use of Judkins catheters and catheter counter-rotation.

figure 36FF4
Fig. 4 Coronary angiogram (right anterior oblique caudal view) shows no residual stenosis or stent malapposition at the previous lesion site in the right coronary artery.
figure 36FF3
Fig. 3 First postprocedural coronary angiogram (left anterior oblique caudal view) shows Thrombolysis In Myocardial Infarction III flow and no stent malapposition in the mid left circumflex coronary artery.
figure 36FF2
Fig. 2 Coronary angiogram (right anterior oblique caudal view) shows a nearly 80% stenosis in the proximal right coronary artery (arrow).
figure 36FF1
Fig. 1 Coronary angiogram (left anterior oblique caudal view) shows an 85% stenosis in the mid left circumflex coronary artery (arrow).

Comment

Dextrocardia with situs inversus is rare (estimated incidence, 1 in 10,000 persons).1 Coronary artery disease in dextrocardia is no more frequent than in the general population.2 There have been few reports of PCI via transradial access in patients with dextrocardia. We successfully performed right transradial PCI twice within 9 days, first to the LCx and then to the right coronary artery. To the best of our knowledge, this is the 1st report of the use of right transradial PCI to treat 2-vessel disease in a patient with dextrocardia.

Footnotes

Address for reprints: Liang-Long Chen, MD, FACC, Department of Cardiology, Union Hospital, Fujian Medical University, 29 Xin-Quan Rd., Fuzhou 350001, PRC

E-mail: nc.moc.oohay@nehc;f5000x#&gnolgnail

References

1. Rosenberg HN, Rosenberg IN. Simultaneous association of situs inversus, coronary heart disease and hiatus hernia; report of a case and review of literature. Ann Intern Med 1949;30 (4):851–9. [PubMed]
2. Hynes KM, Gau GT, Titus JL. Coronary heart disease in situs inversus totalis. Am J Cardiol 1973;31(5):666–9. [PubMed]

Articles from Texas Heart Institute Journal are provided here courtesy of Texas Heart Institute