[Emergent Off-pump Coronary Artery Bypass Grafting in a Patient with Situs Inversus Totalis: Report of a Case]
Kazuo Itoh1, Ryo Taguchi, Nobuaki Suzuki
1Department of Cardiovascular Surgery, Aomori City Hospital, Aomori, Japan.
Insights
This case report details a rare patient with dextrocardia and situs inversus totalis who successfully underwent emergency coronary artery bypass surgery for severe ischemic heart disease. The successful surgical revascularization highlights treatment feasibility in complex congenital anomalies.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Cardiac Surgery
Background:
- Dextrocardia with situs inversus totalis is a rare congenital condition.
- Ischemic coronary artery disease presents unique challenges in patients with dextrocardia.
- Surgical myocardial revascularization is a potential treatment for severe coronary artery disease.
Observation:
- A 76-year-old male with dextrocardia and situs inversus totalis presented with unstable angina and ventricular fibrillation.
- Coronary angiography revealed critical obstructions in the left anterior descending and right coronary arteries, and stenosis in the left circumflex artery.
- Emergency off-pump coronary artery bypass surgery was performed.
Findings:
- The off-pump coronary artery bypass surgery using saphenous vein grafts was technically successful.
- The surgical team adapted their positioning for the unique anatomy during the procedure.
- The patient experienced a mostly uneventful postoperative recovery, with transient renal support and prolonged ventilation.
Implications:
- This case demonstrates the successful surgical management of ischemic heart disease in a patient with dextrocardia and situs inversus totalis.
- It highlights the importance of tailored surgical approaches for complex congenital cardiac anomalies.
- Further research into surgical outcomes for patients with situs inversus and cardiac disease is warranted.
Abstract:
Dextrocardia associated with situs inversus totalis is a rare congenital anomaly. We herein report a patient with this condition and ischemic coronay artery disease who underwent emergency surgical myocardial revascularization. A 76-year-old man was admitted to our hospital with a diagnosis of unstable angina pectoris. He had incessant ventricular fibrillation attack on the second day of hospitalization. Emergent coronary angiography revealed total obstruction of the anatomically left anterior descending and right coronary arteries, and severe stenosis in the anatomically left circumflex artery. Emergent off-pump coronary artery bypass using saphenous vein grafts was successfully performed. Intraoperatively, the main surgeon continuouly stood on the patient's right side except during anastosiso of a vein graft to the left circumflex artery. Postoperative course was almost uneventful aside from transient renal replacement and prolonged ventilation.
