Coronary Artery Bypass Grafting in Dextrocardia. Is There a Challenge?

Dextrocardia with situs inversus is a rare congenital condition, even though known since 1606 when Fabricious first described it. The incidence of coronary artery disease in this group of patients is the same as in general population. First Coronary Artery Bypass Grafting (CABG) in patient with Dextrocardia was performed in 1980. Performing the procedure it is a very challenging task for the surgeon in the terms of planning, choice of conduits, and simultaneous presentation of other congenital conditions. We present a fifty-eight year old, insulin dependent diabetic, hypertensive male on end stage of renal failure, on waiting list for renal transplantation, who found to have severe coronary artery disease on a background of Dextrocardia. The whole procedure was performed under cardiopulmonary bypass with surgeon on the left side of the patient, using the right internal thoracic artery and two vein grafts as conduits. Patient had an unremarkable postoperative course and was discharged on day four postoperatively. His postoperative follow-up was satisfactory and patient is waiting for his renal transplant. Patients with congenital disorders have better survival and cases of ischaemic heart disease on a background of congenital disease will eventually become more frequent. Careful planning of the operation and very good understanding of patho physiology and the anatomy of those patients, are essential for a good outcome.