Complete arterial revascularization in coronary artery bypass grafting in a patient with solitus inversus totalis
A J Poncelet1, R Dion, B Lengele
1Department of Cardiovascular and Thoracic Surgery, Cliniques Universitaires Saint-Luc, Catholic University of Louvain, Louvain, Belgium. Poncelet@chir.ucl.ac.be
Insights
Dextrocardia with complete situs inversus, a rare congenital condition, presents unique challenges for coronary revascularization. This case demonstrates successful complete arterial revascularization in such a patient.
Area of Science:
- Cardiovascular Surgery
- Congenital Heart Disease
- Surgical Anatomy
Background:
- Dextrocardia with complete situs inversus is a rare congenital anomaly affecting approximately 2 in 10,000 live births.
- Coronary revascularization in patients with dextrocardia requires specific technical adaptations due to cardiac malposition.
Observation:
- A case report of an adult patient diagnosed with triple-vessel coronary artery disease and complete situs inversus totalis.
- The patient presented with anatomical challenges necessitating tailored surgical strategies.
Findings:
- Successful complete arterial revascularization was performed using bilateral internal thoracic arteries and the left gastroepiploic artery.
- The left gastroepiploic artery served as the functional equivalent to a right-sided graft in this unique anatomical setting.
Implications:
- This approach highlights the feasibility of utilizing specific arterial conduits for complex coronary revascularization in situs inversus patients.
- It underscores the importance of adapting surgical techniques to overcome anatomical variations for optimal patient outcomes.
Abstract:
Dextrocardia with complete situs inversus is a rare condition that occurs approximately in 2/10,000 live births. Coronary revascularization management in this setting differs in the technical considerations imposed by the malposition of the heart itself. We report here a case of complete arterial revascularization using both internal thoracic arteries and the left (homologous vessel to the right) gastroepiploic artery in an adult patient with triple-vessel disease and situs inversus totalis. Strategies for the choice of conduits and anastomoses as well as technical details are discussed.