Mirror Mirror on the Wall- A Case of Dextrocardia with Situs Inversus

Introduction: Dextrocardia with situs inversus is a rare congenital defect that causes reversal of the thoracic and abdominal organs and vessels. In regards to cardiac anatomy, the apex of the heart is right sided and the coronary ostia are reversed in patients with situs inversus and dextrocardia. Given the reversal of normal anatomic structures, successful coronary angiography requires several adjustments to engage the vessel and interpret the angiography.

Case report: This is a 67 year-old male with a history of dextrocardia with situs inversus and severe aortic stenosis who presented with dyspnea and orthopnea. Echocardiography confirmed critical aortic stenosis. He was referred for valve replacement and underwent coronary angiography. A non-standard counter-clockwise technique was required to engage the right coronary artery and a double inversion technique was utilized to aid in interpretation of the angiogram.

Conclusion: Dextrocardia with situs inversus is a rare congenital defect and when not associated with Kartagener’s carries a normal life expectancy. Therefore it is not unusual that patient’s will need coronary angiography. Several technical modifications are needed for successful angiography.

Author(s): Aniket S Rali, Tyler Buechler, Hema Pamulapati and Tehmeena Shah

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