Successful Percutaneous Coronary Intervention in a Patient with Dextrocardia and Situs Inversus

以經皮穿刺冠狀動脈介入性療法成功治療右位心及內臟逆位之病患

羅鴻舜(Hung-Shun Lo) ； 陳孟麟(Meng-Ling Chen) ； 周柏青(Po-Chin Chou) ； 邱恆正(Herng-Cheng Chiou)

《Acta Cardiologica Sinica》 20卷3期 (2004/09) Pp. 191-196

摘要

右位心乃是一種罕見的先天性發育異常，其特徵為心臟及內臟器官發生鏡像逆位。內臟逆位的右位心與內臟正位或內臟錯位的右位心病患不同的是，其罹患先天性心臟病的機率相當的低。然而，右位心且內臟逆位的人，罹患冠狀動脈心臟病的機率與正常人相同。有關右位心病患接受冠狀動脈血管攝影及經皮穿刺冠狀動脈介入性療法之病例報告並不多見。在此陳述一位七十歲具有右位心的女性，罹患不穩定型狹心症，接受心導管檢查及經皮穿刺冠狀動脈介入性治療。我們在有病變的右冠狀動脈及左前降枝成功地實施經皮穿刺冠狀動脈擴張術暨血管內支架植入術。同時描述一些技術上的問題：導管的選擇為一般常用的標準成型導管，血管攝影影像之擷取選擇鏡像影像加以略作修飾，以及導管運作採取逆向等。

關鍵字

右位心 ； 內臟逆位 ； 經皮穿刺冠狀動脈介入性療法 ； 血管內支架植入術

並列摘要

Dextrocardia is a rare congenital anomaly of development characterized by a mirror- image position of the heart and abdominal viscera. Unlike dextrocardia with situs solitus or ambiguus, the coincidence of congenital heart disease is relative low among dextrocardic patients with situs inversus. However, patients with dextrocardia may suffer from coronary heart disease as do people with normally positioned hearts. Few cases of coronary angiography and percutaneous coronary intervention in patients with dextrocardia have been reported. We describe a 70-year-old female patient with dextrocardia who developed unstable angina and was able to undergo diagnostic catheterization and percutaneous coronary intervention. We successfully performed percutaneous coronary angioplasty followed by coronary stenting to the right coronary artery (RCA) and left anterior descending coronary artery (LAD) and described our experience in the selection of the guiding catheters (standard preformed catheters), angiographic image views acquisition (mirror-image views with subtle modification) and coronary catheter engaging techniques (opposite-direction catheter rotations).

並列關鍵字

Dextrocardia ； Situs inversus ； Percutaneous coronary intervention ； Coronary stenting