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Cox-Maze IV Procedure Concomitant with Valvular Surgery In Situs Inversus Dextrocardia: A Single-Center Experience in China
Published on: February 11, 2022
Successful percutaneous coronary intervention for an in-stent chronic total occlusion in a patient with dextrocardia:
Johannes Wild1, Tommaso Gori2,3, Thomas Münzel2,3,4
1Center for Cardiology - Cardiology I, University Medical Center Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany. johannes.wild@unimedizin-mainz.de.
Insights
This case report details the successful recanalization of a chronic total occlusion within a stent in the right coronary artery of a patient with dextrocardia. This demonstrates feasibility for complex interventions in rare cardiac malpositions.
Area of Science:
- Interventional Cardiology
- Cardiovascular Diseases
- Congenital Heart Malformations
Background:
- Chronic total occlusion (CTO) percutaneous coronary interventions (PCI) are complex.
- CTO PCI in patients with dextrocardia and situs inversus is rare.
- In-stent CTO in this population has not been previously described.
Observation:
- A 69-year-old male with situs inversus totalis and extensive coronary artery disease presented with exertional chest pain.
- Coronary angiography revealed an eight-year-old in-stent chronic total occlusion of the right coronary artery.
- Calcification and collateralization were noted, classifying the lesion as CTO.
Findings:
- Successful recanalization of the in-stent CTO was achieved using an antegrade wire escalation technique.
- This represents the first reported case of in-stent CTO in a patient with situs inversus and dextrocardia.
- The procedure demonstrated the feasibility of complex CTO PCI in this rare anatomical variant.
Implications:
- This case expands the understanding of CTO PCI in complex congenital cardiac malpositions.
- It suggests that advanced PCI techniques can be effective even in challenging anatomical scenarios.
- Further research into CTO PCI outcomes in patients with situs inversus is warranted.
Background:
Percutaneous coronary interventions of chronic total occlusion represent one of the most challenging issues in interventional cardiology. A Caucasian patient with dextrocardia presented with an in-stent chronic total occluded right coronary artery, a constellation which has not been described previously in the literature.
Case Presentation:
A 69-year-old man with pre-known situs inversus totalis and a long history of coronary artery disease with multiple interventions and stent-implantations presented to our department suffering from episodes of chest pain under exercise. A coronary angiogram showed a completely occluded right coronary artery in the area of a drug-eluting stent which had been implanted eight years before. We found collaterals from the left coronary artery system and signs of calcification, so the lesion was classified as chronic total occlusion and the recanalization using an antegrade wire escalation technique successfully performed.
Conclusion:
This is the first reported case of an in-stent chronic total occlusion in situs inversus with dextrocardia. Our experience in this case demonstrates the feasibility of recanalization of in-stent chronic total occlusions even in the rare setting of this congenital cardiac malposition combined with severe coronary artery disease.
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