Itoh Kazuo, Taguchi Ryo, Suzuki Nobuaki
Department of Cardiovascular Surgery, Aomori City Hospital, Aomori, Japan.
Kyobu Geka. 2024 Jun;77(6):446-449.
Dextrocardia associated with situs inversus totalis is a rare congenital anomaly. We herein report a patient with this condition and ischemic coronay artery disease who underwent emergency surgical myocardial revascularization. A 76-year-old man was admitted to our hospital with a diagnosis of unstable angina pectoris. He had incessant ventricular fibrillation attack on the second day of hospitalization. Emergent coronary angiography revealed total obstruction of the anatomically left anterior descending and right coronary arteries, and severe stenosis in the anatomically left circumflex artery. Emergent off-pump coronary artery bypass using saphenous vein grafts was successfully performed. Intraoperatively, the main surgeon continuouly stood on the patient's right side except during anastosiso of a vein graft to the left circumflex artery. Postoperative course was almost uneventful aside from transient renal replacement and prolonged ventilation.
右位心合并完全性内脏转位是一种罕见的先天性异常。我们在此报告一名患有这种疾病并伴有缺血性冠状动脉疾病的患者，该患者接受了急诊外科心肌血运重建术。一名76岁男性因不稳定型心绞痛入院。他在住院第二天发生了持续性心室颤动发作。急诊冠状动脉造影显示，解剖学上的左前降支和右冠状动脉完全阻塞，解剖学上的左旋支动脉严重狭窄。使用大隐静脉移植物成功进行了急诊非体外循环冠状动脉搭桥术。术中，除了将静脉移植物吻合到左旋支动脉时，主刀医生一直站在患者右侧。术后过程除了短暂的肾脏替代治疗和延长通气时间外，几乎平稳。
