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CASE20191030_019
| CORONARY - Acute Coronary Syndromes (STEMI, NSTE-ACS) | |
| A Rare Case of Percutaneous Coronary Intervention in Dextrocardia and ST Elevation Myocardial Infarction | |
| Chong Wei Loong1, Houng Bang Liew1 | |
| Queen Elizabeth II Hospital, Malaysia1, | |
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[Clinical Information]
- Patient initials or identifier number:
BD
-Relevant clinical history and physical exam:
68-year-old gentleman with history of hypertension and dyslipidaemia presented to a district hospital with sudden onset of resting chest pain. Upon presentation, he was haemodynamically stable. Cardiovascular examination revealed right sided apex beat.
-Relevant test results prior to catheterization:
The 12 leads electrocardiogram showed ST elevations in leads II, III, aVF, V5-V6, ST depressions in leads V1-V3 and low voltages in leads V3-V6. Right sided chest leads showed prominent R waves. Thrombolytic therapy was started. He was referred to our center for rescue angioplasty after failed thrombolytic therapy.
  - Relevant catheterization findings:
The procedure was performed via right radial assess using a 6 French system. The left coronary artery was cannulated with Optitorque catheter (5Fr, Terumo). The left coronary artery was on anatomically right side. Mid left anterior descending artery 80% stenosis. The right coronary artery (RCA) was cannulated with the same Optitorque catheter in anti-clockwise rotation at right anterior oblique view. The RCA was dominant and anatomically on the left side. The proximal RCA was occluded.
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[Interventional Management]
- Procedural step:
We proceed with percutaneous coronary angioplasty to the right coronary artery. The right coronary artery was selectively engaged with a 6Fr Judkin left catheter and the lesion was crossed with the Pilot 50 guidewire (Abbot vascular). Pre-dilatation to the proximal right coronary artery was performed with a Sprinter Legend balloon (2.0x12mm, Metrodnic) and a Biofreedom drug eluting stent (3.5x24mm, Biosensors International Ltd) was deployed at 12 atmosphere pressure. Post-dilatation was carried out using NC TREK balloon (3.5x8mm, Abbot Vascular) at 24 atmosphere pressure. TIMI 3 flow achieved.
   - Case Summary:
We report a rare case of successful percutaneous coronary intervention in a patient with dextrocardia and acute myocardial infarction. We demonstrated that coronary angioplasty in dextrocardia via trans-radial approach can be performed effectively with appropriate technical modifications.
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