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Triple-vessel percutaneous coronary revascularization in situs inversus dextrocardia.

Kakouros N, Patel SJ, Redwood S, Wasan BS - Cardiol Res Pract (2010)

Bottom Line: These patients have a high incidence of congenital cardiac disease but their risk of coronary artery disease is similar to that of the general population.We describe the successful use of standard diagnostic and interventional guide catheters with counter rotation and transversely inversed image acquisition techniques.The case also highlights that the right precordial pain may represent cardiac ischemia in this population.

View Article: PubMed Central - PubMed

Affiliation: Johns Hopkins University, Baltimore, MD 21205, USA.

ABSTRACT
Dextrocardia with situs inversus occurs in approximately one in 10,000 individuals of whom 20% have primary ciliary dyskinesia inherited as an autosomal recessive trait. These patients have a high incidence of congenital cardiac disease but their risk of coronary artery disease is similar to that of the general population. We report what is, to our knowledge, the first case of total triple-vessel coronary revascularization by percutaneous stent implantation in a 79-year-old woman with situs inversus dextrocardia. We describe the successful use of standard diagnostic and interventional guide catheters with counter rotation and transversely inversed image acquisition techniques. The case also highlights that the right precordial pain may represent cardiac ischemia in this population.

No MeSH data available.


Related in: MedlinePlus

Double-inversion technique. Panel (a): LAO caudal view (as in Figure 2(a)) with additional horizontal inversion demonstrating apparent “normal” RAO caudal angiographic appearances. Note, also, engagement of the EBU catheter. Panel (b): RAO view of the left-sided right coronary artery with additional horizontal inversion mimicking a conventional LAO view.
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Related In: Results  -  Collection


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fig3: Double-inversion technique. Panel (a): LAO caudal view (as in Figure 2(a)) with additional horizontal inversion demonstrating apparent “normal” RAO caudal angiographic appearances. Note, also, engagement of the EBU catheter. Panel (b): RAO view of the left-sided right coronary artery with additional horizontal inversion mimicking a conventional LAO view.

Mentions: A double-inversion technique of reversed image acquisition and horizontal inversion of on-screen display has been previously described [16]. In our case, angiography and intervention was performed without on-screen reversal of the images. It is still necessary, however, to reverse the transverse angulations whilst maintaining the common cranial/caudal sagittal tilts. A right anterior oblique caudal projection, for example, produces a mirror image “spider view”. Although horizontal image inversion in conjunction with horizontally reversed image acquisition (double inversion) makes the coronary tree appear “normal” (see Figure 3), it also artificially reverses the on-screen response of catheters and angioplasty wires to normal manipulation (torquing). Consequently, although it may aid image interpretation, we found this technique unhelpful for percutaneous intervention.


Triple-vessel percutaneous coronary revascularization in situs inversus dextrocardia.

Kakouros N, Patel SJ, Redwood S, Wasan BS - Cardiol Res Pract (2010)

Double-inversion technique. Panel (a): LAO caudal view (as in Figure 2(a)) with additional horizontal inversion demonstrating apparent “normal” RAO caudal angiographic appearances. Note, also, engagement of the EBU catheter. Panel (b): RAO view of the left-sided right coronary artery with additional horizontal inversion mimicking a conventional LAO view.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2902043&req=5

fig3: Double-inversion technique. Panel (a): LAO caudal view (as in Figure 2(a)) with additional horizontal inversion demonstrating apparent “normal” RAO caudal angiographic appearances. Note, also, engagement of the EBU catheter. Panel (b): RAO view of the left-sided right coronary artery with additional horizontal inversion mimicking a conventional LAO view.
Mentions: A double-inversion technique of reversed image acquisition and horizontal inversion of on-screen display has been previously described [16]. In our case, angiography and intervention was performed without on-screen reversal of the images. It is still necessary, however, to reverse the transverse angulations whilst maintaining the common cranial/caudal sagittal tilts. A right anterior oblique caudal projection, for example, produces a mirror image “spider view”. Although horizontal image inversion in conjunction with horizontally reversed image acquisition (double inversion) makes the coronary tree appear “normal” (see Figure 3), it also artificially reverses the on-screen response of catheters and angioplasty wires to normal manipulation (torquing). Consequently, although it may aid image interpretation, we found this technique unhelpful for percutaneous intervention.

Bottom Line: These patients have a high incidence of congenital cardiac disease but their risk of coronary artery disease is similar to that of the general population.We describe the successful use of standard diagnostic and interventional guide catheters with counter rotation and transversely inversed image acquisition techniques.The case also highlights that the right precordial pain may represent cardiac ischemia in this population.

View Article: PubMed Central - PubMed

Affiliation: Johns Hopkins University, Baltimore, MD 21205, USA.

ABSTRACT
Dextrocardia with situs inversus occurs in approximately one in 10,000 individuals of whom 20% have primary ciliary dyskinesia inherited as an autosomal recessive trait. These patients have a high incidence of congenital cardiac disease but their risk of coronary artery disease is similar to that of the general population. We report what is, to our knowledge, the first case of total triple-vessel coronary revascularization by percutaneous stent implantation in a 79-year-old woman with situs inversus dextrocardia. We describe the successful use of standard diagnostic and interventional guide catheters with counter rotation and transversely inversed image acquisition techniques. The case also highlights that the right precordial pain may represent cardiac ischemia in this population.

No MeSH data available.


Related in: MedlinePlus