Acute total occlusion of left circumflex artery in a patient with dextrocardia and situs inversus

Abstract

We herein present a case of acute left circumflex artery (LCx) occlusion associated with dextrocardia and situs inversus that was successfully treated with drug-eluting stent implantation. The patient was initially diagnosed with non-ST-segment elevation myocardial infarction (NSTEMI) based on an early electrocardiogram. However, coronary angiography demonstrated total occlusion of the LCx. A drug-eluting stent was implanted to cover the culprit lesion, and the coronary flow was completely restored. After the angioplasty, we recorded an electrocardiogram with the lateral leads placed on the right posterior thoracic wall (V7, V8, V9), and subtle ST-segment elevation was revealed in these leads. ST-segment elevation myocardial infarction (STEMI) was subsequently confirmed, and the patient recovered uneventfully. Our case emphasizes the importance of a comprehensive understanding of the electrocardiogram to detect LCx-related acute myocardial infarction in select patients such as those with dextrocardia, in whom the entire clinical situation may look much more complicated. Our experience also demonstrates that treatment with percutaneous coronary intervention is an effective therapeutic option to improve the prognosis of LCx-related acute myocardial infarction in patients with dextrocardia.

Transradial Coronary Intervention in Chronic Total Occlusion in a Patient With Mirror Image Dextrocardia

“…In order to review the techniques used by other operators in successfully performing PCI through TRA in the presence of mirror-image dextrocardia, we searched the databases of PubMed, PubMed Central, Google Scholar, and Cochrane for similar case reports. A total of 11 publications [1][2][3][4][5][6][7][8][9][10][11] were identified ( Table 1), reporting PCI on 17 lesions in 13 patients. Five successful PCIs were reported on occluded vessels [1,4,10,11].…”

“…A total of 11 publications [1][2][3][4][5][6][7][8][9][10][11] were identified ( Table 1), reporting PCI on 17 lesions in 13 patients. Five successful PCIs were reported on occluded vessels [1,4,10,11]. Four of these interventions were done on acute occlusions of ≤24-hour duration [4,10,11], while in the remaining one, the clinical diagnosis was stable ischemic heart disease (IHD), the authors did not specify if the lesion was a CTO [1].…”

“…Five successful PCIs were reported on occluded vessels [ 1 , 4 , 10 , 11 ]. Four of these interventions were done on acute occlusions of ≤24-hour duration [ 4 , 10 , 11 ], while in the remaining one, the clinical diagnosis was stable ischemic heart disease (IHD), the authors did not specify if the lesion was a CTO [ 1 ].…”