Navigating Primary Coronary Angiography in Acute Myocardial Infarction with Dextrocardia: A Case Report on Diagnostic and Procedural Adaptations

Abstract

Aims: Dextrocardia is a rare congenital anomaly characterized by the right-sided position of the heart within the thoracic cavity. Although the prevalence of coronary artery disease (CAD) in this population is comparable to that of the general population, the diagnostic approach and therapeutic strategy can be challenging. Presentation of Case: We report the case of a 66-year-old female with a history of type 2 diabetes and known dextrocardia who presented to our emergency department with acute chest pain, signs of ischemia on electrocardiogram, and regional wall motion abnormalities with reduced ejection fraction on echocardiography. The patient was immediately transferred to the catheterization laboratory for emergency coronary angiography for ongoing pain, the angiography revealed a completely occluded left anterior descending artery (LAD), as for the right coronary artery (RCA), the engagement was difficult with the radial approach, we therefore switched to a femoral access and the injection revealed severe stenosis of the RCA. Primary angioplasty of the culprit LAD lesion was subsequently performed with excellent results. Discussion: Dextrocardia necessitates technical adjustments during coronary angiography and percutaneous coronary intervention (PCI). Coronary views and catheter engagement techniques must be adapted to the anatomical variations. Reports on PCI in patients with dextrocardia remain scarce, particularly in the context of acute myocardial infarction, and no standardized guidelines currently exist. Conclusion: This case highlights the feasibility of primary PCI in such cases using adjusted imaging views and catheterization techniques.