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Left Main Coronary Artery Stenting in Situs Inversus Totalis with Stable Angina

- Operator: Shin Eun-seok, MD

Clinical Presentation

A 68-year old man was admitted due to ongoing severe retrosternal chest pain of two hours duration. His coronary risk factor was hypertension. Eight years ago, he underwent bypass surgery A 57 year-old man was admitted with effort-related chest pain for 3 months. His coronary risk factors were diabetes and hypertension.
His echocardiography showed normal systolic function with impaired relaxation abnormality.

Baseline Coronary Angiogram

1. Left coronary angiogram showed 70-80% stenosis in left main ostium and shaft. (Figure 1)
2. Right coronary angiogram showed no significant stenosis.

Procedure

The anatomical left coronary system (right sided) was engaged with a left 3.5 Judkins catheter. IVUS was employed for accurate lesion assessment and optimal stenting. Predilation before stenting was performed with undersized angioplasty balloon (Maverick 3.0 mm15 mm) (Figure 2). Single Cypher stent (3.5 mm23 mm) was dilated crossover LCX (Figure 3). We had poststent dilation with high pressure balloon (Quatum 4.012 mm) up to 4.14 mm (18 atm) (Figure 4). Coronary angiogram with IVUS showed no residual stenosis in left main shaft and no compromised ostial LCX (Figure 5). Procedural result was favorable.
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