CORONARY ARTERY BYPASS IN DEXTROCARDIA
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2017, Vol 6, Issue 58
Abstract
PRESENTATION OF CASE A 64 years old woman with known situs inversus and dextrocardia presented with complaints of right-sided chest discomfort on exertion since 2 months and history of acute coronary syndrome 1 month back. She was having class 3 symptom for past 10 days. She was a known case of type 2 diabetes mellitus and hypertension for past 15 years. There was no family history of coronary artery disease. Her physical examination was normal except for dextrocardia. Echocardiography showed situs inversus with dextrocardia with moderate left ventricular systolic and diastolic dysfunction. All the valves were essentially normal with regional wall motion abnormality (RWMA) in anteroseptal and apical region. Coronary angiography revealed left main coronary artery disease. Left anterior descending artery (LAD) showed significant osteoproximal obstruction with diffuse distal disease; circumflex showed significant proximal and obtuse marginal (OM1) disease. Right coronary artery (RCA) was normal. She underwent on-pump coronary artery bypass surgery. Intraoperatively, obtuse marginal branch was seen to be very small and not graftable. Right internal mammary artery (RIMA) was harvested and all anastomoses were done with surgeon standing on left side of the patient. RIMA was grafted to left anterior descending artery (LAD). Saphenous vein graft was used to bypass the diagonal artery. There were no postoperative complications and ionotropic requirements. She was extubated after 6 hours and transferred to ward on next day. She was discharged after six days.
Authors and Affiliations
Lokesh Shekher Jaiswal, Milind Padmakar Hote
Keywords
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- DOI 10.14260/Jemds/2017/937
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