Successful percutaneous coronary intervention for chronic total occlusion of right coronary artery in patient with dextr
- PDF / 501,751 Bytes
- 4 Pages / 595.276 x 790.866 pts Page_size
- 78 Downloads / 209 Views
CASE REPORT
Successful percutaneous coronary intervention for chronic total occlusion of right coronary artery in patient with dextrocardia Muhammad Munawar • Beny Hartono • Kurniawan Iskandarsyah • Thach N. Nguyen
Received: 6 September 2012 / Accepted: 6 February 2013 / Published online: 28 February 2013 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2013
Abstract Situs inversus with dextrocardia is rare congenital anomaly. Coronary artery disease in such patients is quite rare. We reported a 52-year-old man with dextrocardia and chronic total occlusion at the proximal right coronary artery just after conus branch and severe stenosis at the proximal left anterior descending artery. He underwent successful percutaneous coronary intervention with stenting of total occluded right coronary artery and simultaneously stenting of the proximal left anterior descending artery. Keywords Dextrocardia Chronic total occlusion Percutaneous coronary intervention
Introduction Dextrocardia is a rare congenital anomaly with a prevalence of 1 in 2,500 general populations [1]. A retrospective review of 5,539 fetal echocardiograms over a 22-year period revealed 46 cases of dextrocardia [2]. The incidence of coronary artery disease in such patients is thought to be similar to that of the general public. Patients with this condition and severe coronary artery disease may pose challenges at presentation, clinical and diagnostic findings and during coronary intervention at cardiac catheterization. To the best of our knowledge, there was no report of M. Munawar (&) B. Hartono K. Iskandarsyah Binawaluya Cardiac Center, Jl. TB Simatupang 71, Jakarta 13650, Indonesia e-mail: [email protected] T. N. Nguyen Community Health Care System, St. Mary Medical Center, Hobart, IN, USA
percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) in patient with dextrocardia. We therefore describe such condition and technical detail of the procedure.
Case report A 45-year-old man admitted to our hospital because of unstable angina pectoris. He had a history of angina on exertion for few months, which has been prescribed with low dose aspirin, nitrate and betablocker by his previous physician. He was unaware of having a situs inversus dextrocardia. Clinical examination revealed a right-sided apex impulse, and chest radiograph confirmed dextrocardia with right-sided aortic arch (Fig. 1). Surface ECG showed a negative P wave in lead I and lead aVL, a positive R wave in the lead aVR, a prominent S wave in the left-sided precordial leads and prominent R wave in right-sided precordial leads, which suggested a situs inversus and dextrocardia (Fig. 2). His cardiac biomarkers (CK-MB and Troponin T) were within normal limit. The cardiovascular risk factors were smoking and dyslipidemia. On the next day, we performed coronary angiogram and ad hoc PCI. Prior the PCI, patient was given a loading dose of aspirin 320 mg and clopidogrel 300 mg, and during the procedure IV, eptifibatide was given. The left main coronary arte
Data Loading...
