Dextrocardia with situs inversus is a rare congenital abnormality with an incidence of only 1:10,000. The incidence of coronary artery disease in this condition is similar to that in the general population.

History

A 66-year-old patient with a diagnosis of left main coronary artery disease and triple vessel disease, was referred for coronary bypass surgery. He was a known case of dextrocardia with situs inversus. He presented with unstable angina. He was a known case of stage 3 chronic renal disease, hypertension and diabetes mellitus. Carotid scan showed bilateral carotid artery stenosis with critical block in the left carotid artery. His coronary angiogram revealed triple vessel disease and dextrocardia.

Surgical Procedure

In preparation for coronary artery bypass surgery, he underwent left carotid endarterectomy. He had an uneventful recovery with no neurological deficit. After six weeks, he was taken up for CABG. Chest was opened through median sternotomy approach. Skeletonized right internal mammary artery (RIMA) was harvested and found to be good size and length and three lengths of long saphenous vein were harvested. Heart was stabilized with a tissue stabilizer device and RIMA was anastomosed to the LAD from the right side. Surgeon came on the left side and stabilized the heart for SVG to ramus intermedius, circumflex PDA and right acute marginal. All the distal anastomoses on those vessels were done from the left side and proximal anastomosis from the right side. Intra and post-op period was uneventful. His serum creatinine went up early post-op period and came down to his pre-op levels in five days’ time. Post-op echo showed normal LV function. He was discharged on 10th post-operative day.

Discussion

Performing CABG in dextrocardiac patient is more difficult and technically challenging as it is not routinely performed. There are few reported cases of CABG in dextrocardia and even lesser number had off-pump approach. Myocardial revascularization in dextrocardia can successfully be achieved with RIMA to the LAD and SVG to other vessels.

Dextrocardia and coronary artery disease Off-pump CABG in dextrocardia and carotid endarterectomy