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Emergent off-pump complete myocardial revascularization in dextrocardia

G Bonanomi1, D Kostov, M A Zenati

  • 1Division of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.

The Journal of Cardiovascular Surgery
|March 26, 2004
PubMed

Insights

Dextrocardia with situs inversus totalis presents unique challenges for treating coronary artery disease. Off-pump myocardial revascularization offered a successful solution for a critically ill patient with acute myocardial infarction.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Medical Imaging

Background:

  • Dextrocardia, a rare congenital condition, involves the heart's displacement to the right side of the chest.
  • Situs inversus totalis is a condition where major visceral organs are mirrored.
  • Coronary artery disease (CAD) can affect patients with dextrocardia, posing complex diagnostic and therapeutic challenges.

Observation:

  • A 72-year-old patient with dextrocardia and situs inversus totalis presented with acute myocardial infarction (MI).
  • The patient experienced complications including congestive heart failure.
  • Severe general condition precluded traditional surgical approaches.

Findings:

  • Emergent off-pump complete myocardial revascularization (OPCAB) was successfully performed.
  • The patient tolerated the complex procedure well, despite the mirror-image anatomy.
  • The patient was discharged asymptomatic, indicating a positive outcome.

Implications:

  • This case highlights the feasibility and benefits of OPCAB in dextrocardia patients with complex CAD.
  • Mirror-image anatomy requires meticulous surgical planning and execution.
  • OPCAB may be a valuable option for critically ill patients with dextrocardia and acute coronary syndromes.

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