Coronary artery bypass grafting in a patient with situs inversus totalis
Taha Okan1, Caner Topaloglu2, Orhan Kucuk3
1Cardiology Department, Kardiya Medical Center, Izmir, Turkey.
Insights
Situs inversus totalis (SIT) with dextrocardia is rare. Coronary CT angiography aids in planning complex coronary artery catheterization, improving safety for patients with this condition.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Situs inversus totalis (SIT) is a rare congenital anomaly where visceral organs are mirrored.
- Dextrocardia combined with SIT occurs in approximately 1:10,000 individuals.
- Coronary heart disease in SIT patients presents similarly to the general population.
Observation:
- Coronary computed tomography (CT) angiography is valuable for assessing coronary artery anatomy in SIT.
- This case highlights invasive coronary angiography (ICA) performed from an atypical angle due to dextrocardia.
- 3D and curved reformatted images from coronary CT angiography were utilized.
Findings:
- Coronary CT angiography accurately visualizes coronary artery origins and positions in SIT.
- The detailed imaging facilitated preprocedural planning for challenging coronary artery catheterization.
- Successful ICA was performed by adapting standard angles to the mirrored anatomy.
Implications:
- Coronary CT angiography enhances the safety and precision of interventional procedures in SIT patients.
- Advanced imaging techniques improve guidewire and catheter manipulation during ICA.
- This approach aids in safer surgical planning for complex cardiac cases involving SIT.
Abstract:
Situs inversus totalis (SIT) describes a complete mirror image of the visceral organs in the thoracic and abdominal cavities. Dextrocardia, in combination with SIT, is a rare congenital anomaly with a frequency of 1:10 000, and coronary heart disease may occur with a similar frequency and manifestation as in the general population. Coronary computed tomography (CT) angiography is useful for accurately assessing the coronary artery origin and position for preprocedural planning of difficult coronary artery catheterisation in SIT. In this case, invasive coronary angiography (ICA) was performed from the same angle but on the opposite side compared to standard angiography. With the use of volume-rendered three-dimensional and curved reformatted images reconstructed from coronary CT angiography, the advancement of guidewires and catheters during ICA as well as the planning of surgical procedures can be performed more safely.
