DEXTROCARDIA: INVERTING THE APPROACH

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Dextrocardia is a rare disorder that occurs in 1 10,000 patients. Unlike situs inversus, this patient had isolated dextrocardia with otherwise normal position of the abdominal organs namely solitus. This anatomy poses diagnostic challenges setting acute coronary syndrome. Coronary angiography was performed without issues proper pre-operative planning and standard catheters techniques via right radial approach. CASE PRESENTATION: A 70-year-old white female past medical history artery disease (CAD), Poland syndrome, dextrocardia, paroxysmal atrial flutter, ischemic cardiomyopathy status post dual chamber implantable cardioverter defibrillator (ICD) presented complaints chest pain at rest concerning for unstable angina. Physical exam significant device implant upper sided heart sounds. Chest x-ray (image A) dextrocardia. Two-dimensional echocardiography right-sided cardiac structures no major valvular liver. treated syndrome heparin, aspirin, Plavix. Her high sensitivity troponin within range. EKG remained stable, she arrhythmias on telemetry. She subsequently underwent an inpatient angiogram (images B-D) found to have mild non-obstructive CAD. Patient safely discharged after escalation her anti-anginal regimen. DISCUSSION: Invasive integral component work-up patients requires delineation anatomy. can be challenging due lack literature diagnosis treatment atherosclerosis congenital disease.Proper catheter selection technique are paramount when approaching engagement arteries. In positions left ostia relation aortic arch sinuses simply mirror-image Therefore, despite difficult anatomy, we were able engage using rotate opposite site direction. The system engaged Judkin's 3.5 4.0 catheter. Although transposed hemithorax, panning appropriately allowed complete visualization CONCLUSIONS: case highlights importance considering preparing invasive angiography. Many cardiologists will see more than one person various types so it important know suffice if paired correct catheters, technique, anatomic considerations. REFERENCE #1: Nair R, Muthukuru SR. Dextrocardia. 2020 Aug 10. In: StatPearls [Internet]. Treasure Island (FL): Publishing; 2021 Jan–. PMID: 32310534. #2: Sinner GJ, George B, Messerli AW. Transradial Approach Angiography Percutaneous Intervention Patients With J Cardiol. 2019 May;31(5):E83-E88. 31034439. DISCLOSURES: No relevant relationships by Akash Patel, source=Web Response Sagar