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Updated: Jul 10, 2025
Cox-Maze IV Procedure Concomitant with Valvular Surgery In Situs Inversus Dextrocardia: A Single-Center Experience in China
Published on: February 11, 2022
Percutaneous coronary intervention for chronic total occlusion of the left circumflex branch in mirror dextrocardia:
Du Hailin1, Qiao Hongtu1, Zhang Wenyong2
1Cardiovascular Department, Chengdu Qingbaijiang District People's Hospital, No.15, Fenghuang East 4th Road, Qingbaijiang District, Chengdu, 610399, Sichuan, China.
Insights
This case study details the successful percutaneous coronary intervention for a rare combination of mirror dextrocardia and chronic total occlusion of the left circumflex artery. The findings highlight unique considerations for treating coronary artery disease in patients with dextrocardia.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Mirror dextrocardia (MDC) presents a rare anatomical variation where the heart is on the right side.
- Patients with MDC and chronic total occlusion (CTO) of the left circumflex branch (LCX) pose unique interventional challenges.
- Standard treatment protocols require significant adaptation for MDC-CTO-LCX cases.
Observation:
- A 51-year-old male with MDC presented with recurrent chest pain and exertional dyspnea.
- Coronary angiography revealed total occlusion of the left circumflex branch (LCX).
- The patient was diagnosed with chronic coronary syndrome and atrial arrhythmia.
Findings:
- Successful percutaneous coronary intervention (PCI) was performed on the occluded LCX in the patient with MDC.
- The procedure involved specific instrument selection and tailored techniques due to the anomalous anatomy.
- Post-PCI, the patient experienced resolution of symptoms and optimal stent placement was confirmed.
Implications:
- This case underscores the need for specialized approaches in interventional cardiology for patients with dextrocardia.
- Careful diagnostic interpretation, particularly of electrocardiograms, is crucial in MDC patients.
- Successful revascularization in MDC-CTO-LCX improves patient outcomes and highlights the feasibility of complex interventions.
Background:
Mirror dextrocardia (MDC) is a condition in which the heart is located in a mirror-image position on the right side of the chest compared to the normal position in individuals with physiological variations. Patients with MDC and chronic total occlusion (CTO) of the left circumflex branch (LCX) are extremely rare in clinical practice. The treatment of MDC-CTO-LCX differs significantly from patients without mirror dextrocardia and the same condition in terms of instrument selection and procedural techniques. In this article, we report a successful case of interventional treatment in a patient with MDC-CTO-LCX. We summarize the anatomical and electrocardiographic variations in patients with MDC-CTO-LCX, and discuss the selection of interventional instruments and techniques that can be useful for interventionists as well as the diagnostic and therapeutic considerations that can be helpful for clinical physicians.
Case Presentation:
A male Han Chinese patient, 51, was admitted, presenting recurrent chest pain for a year and recent onset of exertional fatigue over the past week.He reported episodes of chest pain following physical activities over the past year, lasting between 5 and 20 min.Despite these symptoms, the patient did not seek immediate medical attention, and the occurrence of his chest pain has progressively lessened within the year.A week prior, the patient developed exertional dyspnea after brief walks, though without any episodes of nocturnal paroxysmal dyspnea.Upon arrival at our hospital for evaluation, he was initially diagnosed with chronic coronary syndrome, previous inferior myocardial infarction, atrial arrhythmia, and classified under the New York Heart Association functional class III.Following his admission, a chest X-ray and coronary angiography were conducted.The results indicated mirror dextrocardia and total occlusion of the left circumflex branch. Percutaneous coronary intervention (PCI) was performed on the left circumflex branch. Subsequent angiography demonstrated optimal stent positioning without evidence of hematoma or dissection.Following the procedure, the patient's symptoms of chest pain and exertional dyspnea were resolved, which led to his subsequent discharge.A follow-up electrocardiogram, 10 months post-procedure, displayed a slow and regular atrial rhythm.
Conclusions:
The incidence of dextrocardia is very low, and it may appear normal on an electrocardiogram; however, careful diagnosis is required when there is an abnormal direction of the P wave in limb leads. During the operation for chronic occlusive lesions of the right-sided coronary artery, the anomalous anatomical structure necessitates specific requirements for instrument selection and operative techniques. After revascularization of chronic occlusive vessels in dextrocardia, routine electrocardiographic examination may show false normalization, requiring caution in interpretation.
