Two case reports of coronary artery bypass grafting in adults with dextrocardia with situs inversus

Abstract

In patients with dextrocardia, the cardiac apex points to the right side of the chest wall, and situs inversus is when the internal abdominal organs are positioned on the same side as the cardiac apex. Congenital dextrocardia with situs inversus has been rarely reported, and some patients with dextrocardia also develop atherosclerotic coronary artery disease. We report two cases of on-pump coronary artery bypass grafting performed in patients with dextrocardia with concomitant atherosclerotic coronary artery disease.

The first case was a 56-year-old Thai male who was in a car accident while he experienced a transient ischemic attack (TIA). He was admitted for treatment and underwent an investigation to identify the cause of the TIA. Cardiac echocardiography showed abnormal myocardial contraction. Coronary angiography showed critical three-vessel coronary artery disease. Elective on-pump coronary artery bypass grafting was successfully performed. The second case was a 68-year-old female who presented with non-ST-elevation myocardial infarction. Coronary angiography showed coronary artery disease with a left main lesion. Cardiac echocardiography showed a left ventricular ejection fraction of 33%. Three-vessel coronary artery bypass grafting was performed. The patient experienced good postoperative recovery without any complications.

We conclude that coronary artery bypass grafting in patients with dextrocardia can be successfully performed using the on-pump coronary bypass surgery technique, and the right internal mammary artery is an appropriate arterial conduit for the left anterior descending artery.