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