Navigating Mirrored Anatomy: Primary Percutaneous Coronary Intervention in Dextrocardia

O. Taoussi^1, , H. Kamri¹, H. Rabii¹, M. Mokhtari¹, Z. Azeddoug¹, FZ. Merzouk¹ and G. Benouna¹

¹Department of Cardiology, Cheikh Khalifa International University Hospital, Mohammed VI Foundation of Health and Sciences, Casablanca, Morocco

Cite this paper:
O. Taoussi, H. Kamri, H. Rabii, M. Mokhtari, Z. Azeddoug, FZ. Merzouk and G. Benouna. Navigating Mirrored Anatomy: Primary Percutaneous Coronary Intervention in Dextrocardia. American Journal of Medical Case Reports. 2025; 13(12):84-87. doi: 10.12691/ajmcr-13-12-1

Abstract

Dextrocardia with situs inversus is a rare congenital condition in which thoracoabdominal organs follow a complete mirror orientation. While individuals are often asymptomatic, the management of acute coronary syndrome in this setting poses significant diagnostic and interventional challenges due to reversed anatomical relationships. We report a 60-year-old man with known dextrocardia who presented with acute anterior myocardial infarction. The initial ECG, recorded with standard left-sided precordial leads, failed to show clear ST-segment elevation; however, repositioning the leads to the right hemithorax revealed marked anterior ST elevation. Coronary angiography required systematic technical adaptation, including alternative catheter selection and “mirror-opposite” fluoroscopic projections to visualize the left anterior descending artery correctly. Primary percutaneous coronary intervention was successfully performed using an Amplatz Left 1 catheter for the left coronary artery and an Amplatz Right 1 catheter for the mirrored right coronary ostium. This case underscores the critical need for early recognition of dextrocardia and a structured approach to adapting catheter selection and angiographic views to ensure safe and effective coronary intervention in this challenging anatomical setting.

Keywords:
Dextrocardia Situs inversus Acute coronary syndrome Percutaneous coronary intervention Coronary angiography Anatomical variation

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