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

Abstract

Dextrocardia poses challenges in the percutaneous coronary intervention, particularly through radial access. The presence of chronic total occlusion further adds to the technical difficulties in such cases due to unfamiliar orientations of the coronary arteries, guide catheter instability, and problems in advancing the hardware across the occluded lesions. We report here a successful percutaneous intervention in a chronic total occlusion of the left anterior descending coronary artery, done through right radial access in a patient with situs-inversus and dextrocardia. The trans-radial percutaneous intervention approach is safe and feasible in patients with dextrocardia. Preplanned imaging strategies and the choice of appropriate hardware tremendously help in successfully completing the intervention in such cases.

Therapy of Patients with Cardiac Malposition

“…Percutaneous coronary intervention (PCI) [ 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 ] or surgical coronary artery bypass (CAB) [ 90 ], as deemed appropriate, should be performed promptly. Transradial approach for PCI has also been used successfully [ 91 , 92 ]. Immediate results of both PCIs and CAB [ 77 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 ] appear to be beneficial while long-term results have not been documented.…”

“…Transradial approach for PCI has also been used successfully [ 91 , 92 ]. Immediate results of both PCIs and CAB [ 77 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 ] appear to be beneficial while long-term results have not been documented.…”