PCI in situs inversus with dextrocardia

PCI in situs inversus with dextrocardia

PCI in situs inversus with dextrocardia provides certain challenges to the interventionists. Since we are used to situs solitus with levocardia and the catheter systems are made for such an anatomy, certain innovations are needed in the case of situs inversus dextrocardia. Some take the simple method of inverting the image in the screen and proceed as if in situs solitus levocardia. Another method is the invert the views. For example, while cannulating the right coronary artery (RCA), instead of using the right anterior oblique view (RAO) view, use the left anterior oblique view (LAO) to hook the RCA. Instead of a clockwise torque give a counterclockwise torque for engagement. Once cannulated, then we can proceed almost as in situs solitus levocardia though the views will look like mirror images. This has implications in choosing views without foreshortening while assessing lesion length for estimating balloon size and stent length .