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PP-200 PCI IN A PATIENT WITH SITUS INVERSUS AND DEXTROCARDIA
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Posters / International Journal of Cardiology 155S1 (2012) S129–S227
or radiation induced myocardial fibrosis. This case highlights the importance of TTE in the cases of drug/radiation induced cardiotoxicity.
Figure: The coronary angiogram demonstrates total occlusion of LAD (arrows). Please note that luminal stenosis at before the occlusive segment. PP-200 PCI IN A PATIENT WITH SITUS INVERSUS AND DEXTROCARDIA M.A. Cakar1 , Y. Can1 , I. Kocayigit1 , M.B. Vatan1 , S. Demirtas1 , H. Gunduz1 , R. Akdemir2 . 1 Department of Cardiology, Sakarya Education and Reserarch Hospital, Sakarya, Turkey; 2 Department of Cardiology, Sakarya University Faculty of Medicine, Sakarya, Turkey Objective: Situs inversus with dextrocardia is a rare congenital malposition of heart and thoraco-abdominal viscera. Coronary angiography and percutaneous coronary intervention (PCI) in these patients is technically difficult and requires some modification, such as mirror image angiographic angulation, proper catheter selection and catheter manipulation for selective cannulation of the coronaries. Here we report a male case with dextrocardia and CAD was successfully treated by bare metal stent implantation of a mid lesion of the circumflex (Cx) artery.
was no significant lesion in left anterior descending artery (LAD) and right coronary artery (RCA). We performed PCI and stenting (3.0×14 mm) this lesion using a 6 French coronary Judkins left guiding catheter. Conclusions: Standard angiographic techniques described above using opposite-direction catheter rotations and mirror-image views are useful for both angiography and angioplasty procedures in dextrocardic patients. Our experience in this case demonstrates that coronary angiography and intervention can be performed in cases of dextrocardia with using simple standard catheterization techniques. PP-201 T STENTING FOR LEFT MAIN CORONARY ARTERY STENOSIS 2 ¸ , B. Uluda˘g2 . 1 Department I˙ . Susam1 , Y.T. Yaylalı2 , M. Sanlıalp ˙ of Cardiology, Tepecik Education Research Hospital, Izmir, Turkey; 2 Department of Cardiology, Pamukkale University, Denizli, Turkey Objective: A 41 year-old man presented with unstable angina pectoris. His past medical history was significant for previous stenting of the left anterior descending (LAD)coronary artery with two drug eluting stents. His physical examination was unremarkable. His EKG showed diffuse horizontal ST segment depressions in the precordial leads, V1 through V6. His troponin was positive. (A)
(B)
(C)
(D)
(E)
(F)
Figure 1. LAO 30/CRA 0 view showing %70 lesion in the mid portion of the Cx artery. Methods: A 65-year-old man presented to our institution with the chief complaint of intermittent retrosternal and right anterior chest tightness for 1 month. He was a known case of situs inversus with dextrocardia. Electrocardioogram (ECG) shows the with right-axis deviation of the P wave (negative in aVL and lead I and positive in aVR) and of the QRS complex indicating left to right activation, and low voltage in the left precordial leads. Chest X ray was remarkable for dextrocardia and right-sided stomach bubble. Two-dimensional echocardiogram showed a left-sided liver and dextrocardia and a mild hypokinetic movement in the posterolateral region of the left ventricular wall. Selective coronary angiogram was performed using left and right 6-French 4 cm Judkins diagnostic catheters by counterclockwise rotational movements and torquing. Coronary angiography revealed %70 lesion mid segment of Cx artery which was the presumed cause of the patient’s angina (Figure 1). There
(G)
Figure 1. T Stenting for left main coronary artery stenosis. Methods: His coronary angiography revealed 90% stenosis in the left main coronary artery (LMCA) (Figure 1A), patent stents in the LAD, and 80% stenosis in the proximal circumflex artery (Figure 1B).
Posters / International Journal of Cardiology 155S1 (2012) S129–S227
or radiation induced myocardial fibrosis. This case highlights the importance of TTE in the cases of drug/radiation induced cardiotoxicity.
Figure: The coronary angiogram demonstrates total occlusion of LAD (arrows). Please note that luminal stenosis at before the occlusive segment. PP-200 PCI IN A PATIENT WITH SITUS INVERSUS AND DEXTROCARDIA M.A. Cakar1 , Y. Can1 , I. Kocayigit1 , M.B. Vatan1 , S. Demirtas1 , H. Gunduz1 , R. Akdemir2 . 1 Department of Cardiology, Sakarya Education and Reserarch Hospital, Sakarya, Turkey; 2 Department of Cardiology, Sakarya University Faculty of Medicine, Sakarya, Turkey Objective: Situs inversus with dextrocardia is a rare congenital malposition of heart and thoraco-abdominal viscera. Coronary angiography and percutaneous coronary intervention (PCI) in these patients is technically difficult and requires some modification, such as mirror image angiographic angulation, proper catheter selection and catheter manipulation for selective cannulation of the coronaries. Here we report a male case with dextrocardia and CAD was successfully treated by bare metal stent implantation of a mid lesion of the circumflex (Cx) artery.
was no significant lesion in left anterior descending artery (LAD) and right coronary artery (RCA). We performed PCI and stenting (3.0×14 mm) this lesion using a 6 French coronary Judkins left guiding catheter. Conclusions: Standard angiographic techniques described above using opposite-direction catheter rotations and mirror-image views are useful for both angiography and angioplasty procedures in dextrocardic patients. Our experience in this case demonstrates that coronary angiography and intervention can be performed in cases of dextrocardia with using simple standard catheterization techniques. PP-201 T STENTING FOR LEFT MAIN CORONARY ARTERY STENOSIS 2 ¸ , B. Uluda˘g2 . 1 Department I˙ . Susam1 , Y.T. Yaylalı2 , M. Sanlıalp ˙ of Cardiology, Tepecik Education Research Hospital, Izmir, Turkey; 2 Department of Cardiology, Pamukkale University, Denizli, Turkey Objective: A 41 year-old man presented with unstable angina pectoris. His past medical history was significant for previous stenting of the left anterior descending (LAD)coronary artery with two drug eluting stents. His physical examination was unremarkable. His EKG showed diffuse horizontal ST segment depressions in the precordial leads, V1 through V6. His troponin was positive. (A)
(B)
(C)
(D)
(E)
(F)
Figure 1. LAO 30/CRA 0 view showing %70 lesion in the mid portion of the Cx artery. Methods: A 65-year-old man presented to our institution with the chief complaint of intermittent retrosternal and right anterior chest tightness for 1 month. He was a known case of situs inversus with dextrocardia. Electrocardioogram (ECG) shows the with right-axis deviation of the P wave (negative in aVL and lead I and positive in aVR) and of the QRS complex indicating left to right activation, and low voltage in the left precordial leads. Chest X ray was remarkable for dextrocardia and right-sided stomach bubble. Two-dimensional echocardiogram showed a left-sided liver and dextrocardia and a mild hypokinetic movement in the posterolateral region of the left ventricular wall. Selective coronary angiogram was performed using left and right 6-French 4 cm Judkins diagnostic catheters by counterclockwise rotational movements and torquing. Coronary angiography revealed %70 lesion mid segment of Cx artery which was the presumed cause of the patient’s angina (Figure 1). There
(G)
Figure 1. T Stenting for left main coronary artery stenosis. Methods: His coronary angiography revealed 90% stenosis in the left main coronary artery (LMCA) (Figure 1A), patent stents in the LAD, and 80% stenosis in the proximal circumflex artery (Figure 1B).