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Repeat Stenting in Dextrocardia via the Right Radial Artery: The Right Approach to the Right-sided Heart.
Interventional cardiologist Jack P. Chen, MD
Center Saint Joseph's Hospital of Atlanta
History We had previously performed post-infarct transradial percutaneous coronary intervention (TRPCI)in a 53-year old gentleman with dextrocardia (DC) 5 years ago. A 3.5 x 18 mm Tetra stent was directly deployed into the mid left anterior descending artery (LAD). Recent nuclear stress test revealed anterior ischemia, and the patient was scheduled for repeat right transradial cardiac catheterization and PCI. He has a history of previous nephrectomy and was pretreated with acetylcysteine and sodium bicarbonate infusion.

Admission chest x-ray revealed a mid-thoracic cardiac silhouette as well as rightward pointed cardiac apex. Repeat transradial catheterization revealed a focal 90% in-stent restenosis in the mid-left anterior descending artery. Both left and right coronaries were easily engaged with an Amplatz Left-1 diagnostic catheter.
Strategy

Repeat TRPCI with an Amplatz guide catheter.
Procedure and follow-up Although the diagnostic catheterization was accomplished with an Amplatz Left-1 catheter, subsequent TRPCI required an Amplatz Left-2 guide catheter. The stenosis was easily directly stented with a 3.5 x 12 mm Taxus (Boston Scientific) drug-eluting stent without residual stenosis. Contrast use was 75cc for the combined procedure.

The patient had an uncomplicated course and was discharged home the following day, with no change in creatinine.

Follow-up office examination 2 weeks later revealed a normal right upper extremity vascular examination. He has remained symptom-free for 6 months.
Comments This is the first reported case of transradial catheterization, PCI, or repeat PCI in a dextrocardia patient. Although a somewhat nontraditional guide catheter was used, this case illustrates the ease of TRPCI, even in complex anatomies. Operators are encouraged to use this approach even in renally compromised patients, as contrast load can be minimized. Moreover, we further demonstrated that repeat ipsilateral transradial access, an area of concern for some, is feasible and safe.