Akademik Veri Yönetim Sistemi
TKD2020DİJİTAL 27. Ulusal Uygulamalı Girişimsel Kardiyoloji Toplantısı, İstanbul, Türkiye, 12 - 15 Kasım 2020, ss.1-2
Osman Yesildag, Batur Gönenç Kanar, Dursun Akaslan, Alper Kepez, Halil Ataş
Marmara University Medical School,Department of Cardiology Pendik / İstanbul
62 year-old male admitted to our clinics with the complaint of chest pain It was learned that he was smoking approximately for 40 years.He had not any other risk factor.
Physical examination:, BP: 140/80 mm Hg,Pulse rate: 84/min,
Cardiac apex was on the right side.There was no extra sound or murmur with cardiac auscultation.
Liver was not palpable
Extremity exam. showed patent distal peripheral vessel and no edema.
Lab. examination
Fasting blood sugar: 94 mg/dl
BUN: 16 mg/dl, Creatinine. 0.9mg/dl, Total cholesterol: 169 mg/dl, HDL: 34 mg/dl and LDL-C: 134 mg/dl
Troponin and CK-MB were within normal limit.
Chest X-ray showed clear lung fields and dextrocardia.
ECG was completely normal.
Echocardiographic exam showed normal left ventricular systolic function. There was no MR and TR.
Myocard perfusion scan showed no ischemia but coronary CT angiography was pathologic.Severe stenotic lesions were present both proximal LAD and Cx.. RCA was dominant and has no stenosis. Coronary angiography proved the same lesions.(Figure-1 and 2) and PCI was planned later.Right radial artery was used for access route.By using 6F EBU size 4 guiding catheter, predilatation was performed for both lesions with 2x15 mm monorail balloon and (DES) 3x32 mm stent was implanted for Cx artery stenosis at 18 atmospher and subsequently postdilatation was done with 3.5X18 mm Nc balloon. For LAD
lesion 2.5x20 mm (DES) stent was implanted.and postdilatation was performed with 2.75x12 mm NC balloon /Figure 3) The result was excellent.
Discussion
Even though dextrocardia occurs rarely, these people have similar incidence of coronary artery disease like normal population. Because of unfamiliarity with the reverse anatomy transradial coronary angiography and angioplasty is seldom tried in these patients. Percutaneous coronary intervention (PCI) in these patients is technically difficult because of the mirror image of organs.
This case suggested that the interventional management of such patients follows the same general rules as for non-dextrocardia patients,The left coronary artery (LCA) was cannulated with clockwise rotation of the catheter, while taking the right anterior oblique 45° projection position. The catheter was rotated counterclockwise for cannulating the right coronary artery, instead of the usual clockwise approach. During the RCA angiography, the projected position needed to be changed to the left anterior oblique 45° projection position, while the head and foot projection position did not need to change.ion of the catheter and projection position choices need to be taken into consideration to obtain optimal benefits for the patient.
In conclusion, interventional management of dextrocardia patients follows the same general rules as for non-dextrocardia patients, but some technical details, such as the mirror image, different manipulation of the catheter and projection position choices should be taken into consideration to obtain optimal benefits for the patient.
Keywords: Dextrocardia, PCI,stentOsman Yesildag, Batur Gönenç Kanar, Dursun Akaslan, Alper Kepez, Halil Ataş
62 year-old male admitted to our clinics with the complaint of chest pain It was learned that he was smoking approximately for 40 years.He had not any other risk factor.
Physical examination:, BP: 140/80 mm Hg,Pulse rate: 84/min,
Cardiac apex was on the right side.There was no extra sound or murmur with cardiac auscultation.
Liver was not palpable
Extremity exam. showed patent distal peripheral vessel and no edema.
Lab. examination
Fasting blood sugar: 94 mg/dl
BUN: 16 mg/dl, Creatinine. 0.9mg/dl, Total cholesterol: 169 mg/dl, HDL: 34 mg/dl and LDL-C: 134 mg/dl
Troponin and CK-MB were within normal limit.
Chest X-ray showed clear lung fields and dextrocardia.
ECG was completely normal.
Echocardiographic exam showed normal left ventricular systolic function. There was no MR and TR.
Myocard perfusion scan showed no ischemia but coronary CT angiography was pathologic.Severe stenotic lesions were present both proximal LAD and Cx.. RCA was dominant and has no stenosis. Coronary angiography proved the same lesions.(Figure-1 and 2) and PCI was planned later.Right radial artery was used for access route.By using 6F EBU size 4 guiding catheter, predilatation was performed for both lesions with 2x15 mm monorail balloon and (DES) 3x32 mm stent was implanted for Cx artery stenosis at 18 atmospher and subsequently postdilatation was done with 3.5X18 mm Nc balloon. For LAD
lesion 2.5x20 mm (DES) stent was implanted.and postdilatation was performed with 2.75x12 mm NC balloon /Figure 3) The result was excellent.
Discussion
Even though dextrocardia occurs rarely, these people have similar incidence of coronary artery disease like normal population. Because of unfamiliarity with the reverse anatomy transradial coronary angiography and angioplasty is seldom tried in these patients. Percutaneous coronary intervention (PCI) in these patients is technically difficult because of the mirror image of organs.
This case suggested that the interventional management of such patients follows the same general rules as for non-dextrocardia patients,The left coronary artery (LCA) was cannulated with clockwise rotation of the catheter, while taking the right anterior oblique 45° projection position. The catheter was rotated counterclockwise for cannulating the right coronary artery, instead of the usual clockwise approach. During the RCA angiography, the projected position needed to be changed to the left anterior oblique 45° projection position, while the head and foot projection position did not need to change.ion of the catheter and projection position choices need to be taken into consideration to obtain optimal benefits for the patient.
In conclusion, interventional management of dextrocardia patients follows the same general rules as for non-dextrocardia patients, but some technical details, such as the mirror image, different manipulation of the catheter and projection position choices should be taken into consideration to obtain optimal benefits for the patient.
Keywords: Dextrocardia, PCI,stent