Myocardial revascularization in dextrocardia with situs inversus]

BACKGROUND: The incidence of coronary artery disease in patients with dextrocardia associated with situs inversus is similar to that of the general population: Nevertheless, there are few papers regarding surgical myocardial revascularization in these patients. METHODS: We report two patients with dextrocardia and situs inversus who underwent myocardial revascularization by means of coronary artery bypass grafting, with the right internal mammary artery to the left anterior descending coronary artery in one case and with the left internal mammary artery as a free graft to the left anterior descending coronary artery associated with the repair of an aneurysm of the right coronary sinus of Valsalva in the second patient. RESULTS: There were no surgical complications; the patients were discharged on the 4th and 7th postoperative days, respectively. They are alive and well after 24 and 60 months of follow-up respectively. CONCLUSIONS: This report suggests that durable myocardial revascularization in dextrocardia with situs inversus can be successfully achieved with right or left mammary artery bypass grafting to the left anterior descending coronary artery. The advantage of using an in situ mammary artery is discussed.     

A Novel Conduit-Lengthening Technique to Facilitate the Arterial Switch Operation in an Infant with a Problematic Combination of Coronary Anomolies

We report the technical aspects of the arterial switch operation as we performed it in a 5-month-old infant who had situs inversus, dextrocardia, transposition of the great arteries, and inverted origin of the circumflex and right coronary arteries. The successful performance of this procedure required the use of a conduit-lengthening technique due to the much longer distance to the proposed site of coronary artery transfer.Key words: Abnormalities, multiple/surgery; cardiovascular surgical procedures/methods; coronary vessel anomalies/surgery; dextrocardia; heart defects, congenital/surgery; situs inversus; transposition of great vessels/surgeryThe arterial switch operation is the currently preferred management option for patients who have a diagnosis of d-transposition of the great arteries (d-TGA) with or without a ventricular septal defect (VSD), provided that left and right ventricular size and function are normal. The techniques of this operation are fairly standard, particularly in patients who have atrial and visceral situs solitus. However, there are few data about the intraoperative problems and available surgical approaches in patients who have d-TGA, dextrocardia, and situs inversus.^1,2 We describe the technical considerations of the arterial switch operation in one such patient.     

Situs inversus and coronary artery disease

Situs inversus is a rare condition and there are few reports of myocardial revascularization in such patients. A 56-year-old woman with situs inversus totalis and coronary artery disease underwent successful anastomosis of the right internal mammary artery to the anterior descending coronary artery, and a saphenous vein graft to the right coronary artery.     

Coronary arteries in crisscross heart

Crisscross heart, or superoinferior ventricles, is a complex and often confusing congenital anomaly. We report a heretofore unreported presentation of "isolated" crisscross heart in situs inversus levocardia, which allows us to more clearly define the typical features of crisscross ventricles. The case of this 41-year-old woman, who had a peculiar coronary anatomy, underscores the concept that coronary artery anatomy is strictly related to the myocardial mass served. In complex congenital heart defects, development of an anterior descending artery is possible (as a primary artery, along with the circumflex and right coronary arteries) only if the ventricular septum develops properly and is aligned with the semilunar valves. We use the present case of crisscross heart to illustrate the spectrum of anomalies that can occur during formation of the cardiac apex; this spectrum ranges from a normal apex, to a diverted apex (as in dextroversion in situs solitus), to a crisscross anomaly.     

The feasibility of using Ikari left catheter via the right radial approach in a patient with dextrocardia for better guiding support

Dextrocardia with situs inversus is a rare cardiac anomaly, and the incidence of ischemic heart disease is the same as the general population. In most of these patients, interventionalists may encounter technical difficulties while handling guiding catheters and acquiring more back-up forces. We describe a case of successful anatomical right coronary intervention with Ikari left guiding catheter in a patient with situs inversus.     

Situs inversus totalis and secondary biliary cirrhosis: a case report

Situs inversus totalis is is a congenital anomaly associated with various visceral abnormalities, but there is no data about the relationship between secondary biliary cirrhosis and that condition. We here present a case of a 58 year-old female with situs inversus totalis who was admitted to our clinic with extrahepatic cholestasis. After excluding all potential causes of biliary cirrhosis, secondary biliary cirrhosis was diagnosed based on the patient's history, imaging techniques, clinical and laboratory findings, besides histolopathological findings. After treatment with tauroursodeoxycholic acid, all biochemical parameters, including total/direct bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and gama glutamyl transferase, returned to normal ranges at the second month of the treatment. We think that this is the first case in literature that may indicate the development of secondary biliary cirrhosis in a patient with situs inversus totalis. In conclusion, situs inversus should be considered as a rare cause of biliary cirrhosis in patients with situs inversus totalis which is presented with extrahepatic cholestasis.     

Right mammary-coronary anastomosis in a patient with situs inversus

We report a patient with situs inversus and ischemic heart disease who had myocardial revascularization with anastomosis of the right mammary artery to the anterior descending coronary artery.     

Situs inversus totalis associated with subaortic and subpulmonic stenosis.

The unusual occurrence of total situs inversus and idiopathic hypertrophic subaortic stenosis with the demonstration of right and left heart dynamic obstruction in one patient is presented. The fact that the patient was known to have a rare abnormality (total situs inversus) and the presenting symptom being angina pectoris, may have obscured the diagnosis of IHSS and emphasized the value of comprehensive evaluation of patients. The documentation of right ventricular dynamic obstruction, in addition to obstruction of the left side of the heart, was facilitated by the use of simultaneous pressure recordings in the pulmonary artery and in the body of the right ventricle. The angina-like pain was secondary to left ventricular outflow obstruction, rather than to coronary disease.     

Mechanical reperfusion during acute myocardial infarction in a patient with dextrocardia

Mechanical reperfusion is the preferred treatment for acute ST-elevation myocardial infarction, we describe a case of successful primary angioplasty and stenting in a patient with dextrocardia and situs inversus. Dextrocardia with complete situs inversus is a rare condition, occurring in about 2 in 10,000 live births. However, ischemic heart disease and myocardial infarction have been reported in patients with dextrocardia, and hence the coexistence of myocardial infarction and dextrocardia is not unusual. The incidence of atherosclerosis in this group is not known, but is considered to be the same as that in the general population. There have been a few reports of percutaneous coronary intervention in these patients. We describe a case of primary angioplasty and stenting in a patient with dextrocardia and situs inversus and the electrocardiographic correlation of successful myocardial reperfusion.     

Late right pulmonary artery stenosis after arterial switch operation in mirror image dextrocardia and situs inversus totalis

The operation of D-transposition of the great arteries is performed extremely rarely in patients with mirror image dextrocardia and situs inversus totalis. Therefore, it is not surprising that such unusual anatomy case presents problems with primary operation. We present a case of late right pulmonary artery stenosis after neonatal surgical anatomic correction of mirror image dextrocardia and situs inversus totalis.     

Situs inversus and acute coronary syndrome

Dextrocardia is a rare clinical phenomenon with a reported incidence of one in 10 000. Consequently, acute coronary syndromes in such patients are rare. When chest pain occurs in this setting, it is important to be aware of the unique problems that may occur if coronary intervention is contemplated. Previous case reports have shown successful attempts at reperfusing one coronary artery percutaneously. In this case, coronary stents were successfully deployed in two vessels of a man with situs inversus, which has not been reported before. Additionally, the angiographic results that followed from successful intervention did not produce the expected haemodynamic and electrocardiographic changes.     

Laparoscopic hemicolectomy in a patient with situs inversus totalis

As among persons with normal anatomy, occasional patients with situs inversus develop malignant tumors. Recently, several laparoscopic operations have been reported in patients with situs inversus. We describe laparoscopic hemicolectomy with radical lymphadenectomy in such a patient. Careful consideration of the mirror-image anatomy permitted safe operation using techniques not otherwise differing from those in ordinary cases. Thus, curative laparoscopic surgery for colon cancer in the presence of situs inversus is feasible and safe.     

Incidentally Found Situs Inversus with Dextrocardia: Inferior Myocardial Infarction in an 86‐Year‐Old Woman

Situs inversus with dextrocardia is a rare condition. Yet, the incidence of atheroclerosis and myocardial infarction in patients with dextrocardia is similar to that in general population. The diagnosis of acute myocardial infarction is somewhat tricky and difficult if the dextrocardia is not recognized. We present the electrocardiogram, coronary angiograms, and chest radiogram of a patient with incidentally found situs inversus with dextrocardia.     

Coronary stenting in patients with situs viscerum inversus

Atherosclerotic coronary disease may develop even in patients with complex cardiovascular anomalies who reach adult life. Coronary revascularization (surgical or interventional) may present potential difficulties related to the unusual anatomy. We describe two cases of situs viscerum inversus who underwent cardiac catheterization and angiography as adults because of ingravescent angina. The study identified the cardiac relations and connections, and diagnosed severe coronary disease that was successfully treated with coronary angioplasty and stent implantation. The implications of performing such procedures in patients with similar cardiac anomalies are discussed.     

Laparoscopic cholecystectomy in a patient with situs inversus totalis

INtroDUCtIoNSitus inversus totalis (SIT) is a very uncommon entity. It was first reported by Fabricius in 1600[1]. The incidenceis thought to be in the range of 1:10 000 to 1:20 000[2]. Transposition of the organs may also affect thoracic organs, besides …     

Coronary angioplasty in a patient with situs inversus totalis and a single coronary artery

A patient with congenital situs inversus totalis and a single coronary artery was referred for revascularization because of progressive disabling angina. Exercise thallium scintigraphy had disclosed ischaemia in the anterolateral, posterolateral, and inferior wall of the left ventricle. Percutaneous transluminal coronary angioplasty was performed successfully for stenoses in the right coronary artery.     

Corrected transposition of the great arteries with previously unreported cardiac anomalies

The corrected transposition of the great arteries is a rare congenital cardiac anomaly characterised by atrio-ventricular and ventriculo-arterial discordance and is related to the largest incidence of cardiological complications. We report on a 40-year-old woman with congenitally corrected transposition of the great arteries, situs inversus, atrial septal defect, pulmonary stenosis, right arcus aorta and coronary artery anomalies.     

Myocardial revascularization in a patient with situs inversus totalis

We report the case of a patient with dextrocardia and situs inversus totalis associated with obstructive coronariopathy in the anterior and posterior descending arteries, right coronary artery, first diagonal branch and left marginal branch. The patient underwent coronary artery bypass grafting surgery. This surgery has been rarely reported in literature and we found only one similar case in the national medical literature. The myocardial revascularization was carried out with the right mammary artery for the anterior descending artery. The saphenous vein anastomosed the aorta to the right coronary artery, left marginal branch, fist diagonal branch and posterior descending artery. The surgery was performed with extracorporeal circulation.     

Percutaneous biliary intervention for primary sclerosing cholangitis in a patient with situs inversus totalis

Situs inversus totalis is a rare condition that may not cause symptoms and often occurs concomitantly with other congenital anomalies. Special attention must be given to these patients when invasive interventions are required. There are only a few reports concerning percutaneous transhepatic biliary interventions in situs inversus totalis, but technical details were not fully explained. In this report, we attempt to explain the technical details of percutaneous transhepatic cholangiography, percutaneous biliary drainage and percutaneous biliary balloon dilatation in a patient with known primary sclerosing cholangitis and situs inversus totalis. While performing percutaneous biliary interventions in patients with situs inversus totalis, the key point is to use the mirror image of the traditional technique in an imaginary line dissecting the midline of the abdomen.