Transradial Approach to Coronary Angiography and Percutaneous Intervention in Patients with Dextrocardia with Situs Inversus.

Abstract

Background: Patients with dextrocardia pose unique challenges in coronary angiography and percutaneous intervention due to variations in coronary artery anatomy. Accessing and manipulating coronary arteries in these patients require careful consideration due to their mirror-image anatomy. Radial artery access has emerged as a potential solution, but its efficacy and feasibility in dextrocardia patients need further exploration.

Case Presentation: We present a case of a patient with dextrocardia and situs inversus who underwent coronary angiography and percutaneous intervention. The patient's anomalous coronary artery anatomy posed challenges in accessing and engaging the target vessel using conventional techniques. Radial artery access was chosen, and an AR catheter (Amplatz right) was utilized to navigate the anomalous right coronary artery. Additionally, mirror-image fluoroscopy techniques were employed to facilitate catheter manipulation.

Management & Results: Proper preparation and utilization of radial artery access enabled successful diagnostic and therapeutic coronary interventions in the patient with dextrocardia. The AR catheter proved to be instrumental in accessing the anomalous coronary anatomy, overcoming the technical difficulties associated with conventional catheters. Mirror-image fluoroscopy provided valuable guidance during catheter manipulation, enhancing procedural success.

Conclusion: The transradial approach represents a viable option for coronary angiography and percutaneous intervention in patients with dextrocardia. Careful consideration of coronary anatomy variations, along with appropriate catheter selection and imaging techniques, can facilitate successful procedures in this unique patient population. Further studies are warranted to validate the efficacy and safety of this approach in a larger cohort of dextrocardia patients.