Beyond Mirror Imaging: Rotational Atherectomy in Dextroversion

To describe, to our knowledge, the first reported case of how to safely and effectively complete complex percutaneous coronary intervention in a patient with dextroversion and a severely calcified obstructive lesion in the left anterior descending coronary artery.

A 68-year-old man with self-reported dextrocardia and progressive angina underwent preprocedural coronary computed tomography angiography, which diagnosed dextroversion, multivessel disease, and a calcium score of 1,089. Horizontal fluoroscopic inversion was applied and improved visual familiarity but did not restore true anatomical orientation. Under intravascular ultrasound guidance, a severely calcified left anterior descending lesion was treated with rotational atherectomy (1.5-mm burr) and drug-eluting stent implantation.

In patients with dextrocardia, including dextroversion, defining anatomy before cardiac catheterization can help increase efficiency and enhance safety in this group, especially for complex percutaneous coronary intervention.

Unlike mirror-image dextrocardia, dextroversion lacks true mirror anatomy, so fluoroscopic mirroring alone cannot "normalize" orientation. Preprocedural computed tomography angiography and intraprocedural intravascular imaging were essential for anatomic clarification and allowed safe, effective complex percutaneous coronary intervention.