Repeat right transradial percutaneous coronary intervention in a patient with dextrocardia: The right approach to the right-sided heart

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Abstract
Dextrocardia (DC) is a rare cardiac condition in which the cardiac location, as well as apex, is rightwardly displaced. As the incidence of atherosclerotic disease is similar to that of the general population, there have been few reports of percutaneous coronary interventions (PCIs) in these patients. Proposed technical strategies for successful angiography and PCI in DC include counter-directional torquing of the catheter, as well as right-left mirror-image inversion angiographic views. All previous reports of DC PCIs have been via transfemoral access.We present a case of successful repeat transradial PCI in a patient with DC. This is first report of transradial coronary angiography, PCI, or repeat PCI in a DC patient. A literature review of technical considerations, including our own recommendations for guide catheter selection, are discussed. We also review the anatomic variations and epidemiology of DC. Although access complications for transradial PCI is known to be lower than that of the transfemoral approach, challenges in technique and concern of repeat access have limited the popularity of the former. Our report demonstrates the safety and feasibility of transradial angiography, PCI, and even repeat PCI, in the rare patient with DC.