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Abstract：
BACKGROUND: Mirror dextrocardia (MDC) is a condition in which the heart is located in a mirror-image position on the right side of the chest compared to the normal position in individuals with physiological variations. Patients with MDC and chronic total occlusion (CTO) of the left circumflex branch (LCX) are extremely rare in clinical practice. The treatment of MDC-CTO-LCX differs significantly from patients without mirror dextrocardia and the same condition in terms of instrument selection and procedural techniques. In this article, we report a successful case of interventional treatment in a patient with MDC-CTO-LCX. We summarize the anatomical and electrocardiographic variations in patients with MDC-CTO-LCX, and discuss the selection of interventional instruments and techniques that can be useful for interventionists as well as the diagnostic and therapeutic considerations that can be helpful for clinical physicians.
METHODS: A male Han Chinese patient, 51, was admitted, presenting recurrent chest pain for a year and recent onset of exertional fatigue over the past week.He reported episodes of chest pain following physical activities over the past year, lasting between 5 and 20 min.Despite these symptoms, the patient did not seek immediate medical attention, and the occurrence of his chest pain has progressively lessened within the year.A week prior, the patient developed exertional dyspnea after brief walks, though without any episodes of nocturnal paroxysmal dyspnea.Upon arrival at our hospital for evaluation, he was initially diagnosed with chronic coronary syndrome, previous inferior myocardial infarction, atrial arrhythmia, and classified under the New York Heart Association functional class III.Following his admission, a chest X-ray and coronary angiography were conducted.The results indicated mirror dextrocardia and total occlusion of the left circumflex branch. Percutaneous coronary intervention (PCI) was performed on the left circumflex branch. Subsequent angiography demonstrated optimal stent positioning without evidence of hematoma or dissection.Following the procedure, the patient\'s symptoms of chest pain and exertional dyspnea were resolved, which led to his subsequent discharge.A follow-up electrocardiogram, 10 months post-procedure, displayed a slow and regular atrial rhythm.
CONCLUSIONS: The incidence of dextrocardia is very low, and it may appear normal on an electrocardiogram; however, careful diagnosis is required when there is an abnormal direction of the P wave in limb leads. During the operation for chronic occlusive lesions of the right-sided coronary artery, the anomalous anatomical structure necessitates specific requirements for instrument selection and operative techniques. After revascularization of chronic occlusive vessels in dextrocardia, routine electrocardiographic examination may show false normalization, requiring caution in interpretation.
METHODS: A male Han Chinese patient, 51, was admitted, presenting recurrent chest pain for a year and recent onset of exertional fatigue over the past week.He reported episodes of chest pain following physical activities over the past year, lasting between 5 and 20 min.Despite these symptoms, the patient did not seek immediate medical attention, and the occurrence of his chest pain has progressively lessened within the year.A week prior, the patient developed exertional dyspnea after brief walks, though without any episodes of nocturnal paroxysmal dyspnea.Upon arrival at our hospital for evaluation, he was initially diagnosed with chronic coronary syndrome, previous inferior myocardial infarction, atrial arrhythmia, and classified under the New York Heart Association functional class III.Following his admission, a chest X-ray and coronary angiography were conducted.The results indicated mirror dextrocardia and total occlusion of the left circumflex branch. Percutaneous coronary intervention (PCI) was performed on the left circumflex branch. Subsequent angiography demonstrated optimal stent positioning without evidence of hematoma or dissection.Following the procedure, the patient\'s symptoms of chest pain and exertional dyspnea were resolved, which led to his subsequent discharge.A follow-up electrocardiogram, 10 months post-procedure, displayed a slow and regular atrial rhythm.
CONCLUSIONS: The incidence of dextrocardia is very low, and it may appear normal on an electrocardiogram; however, careful diagnosis is required when there is an abnormal direction of the P wave in limb leads. During the operation for chronic occlusive lesions of the right-sided coronary artery, the anomalous anatomical structure necessitates specific requirements for instrument selection and operative techniques. After revascularization of chronic occlusive vessels in dextrocardia, routine electrocardiographic examination may show false normalization, requiring caution in interpretation.
摘要：
背景：镜像右位心（MDC）是一种情况，与具有生理变化的个体的正常位置相比，心脏位于胸部右侧的镜像位置。MDC和左回旋支（LCX）慢性完全闭塞（CTO）的患者在临床实践中极为罕见。MDC-CTO-LCX的治疗与没有镜像右位心和相同条件的患者在器械选择和手术技术方面存在显着差异。在这篇文章中,我们报道一例MDC-CTO-LCX患者介入治疗的成功病例.我们总结了MDC-CTO-LCX患者的解剖和心电图变化，并讨论对介入医师有用的介入仪器和技术的选择，以及对临床医师有用的诊断和治疗考虑。
方法：一名男性汉族患者，51，被录取了，在过去的一周中出现反复发作的胸痛，最近出现劳力性疲劳。他报告说，在过去的一年里，身体活动后出现了胸痛，持续5至20分钟。尽管有这些症状,病人没有立即就医，他的胸痛在一年内逐渐减轻。一周前,患者在短暂散步后出现劳力性呼吸困难，尽管没有任何夜间阵发性呼吸困难的发作。一到达我们医院接受评估，他最初被诊断出患有慢性冠状动脉综合征，先前的下壁心肌梗死，房性心律失常,并归入纽约心脏协会功能等级III。在他承认之后,进行了胸部X线和冠状动脉造影.结果表明镜像右位心和左回旋支完全闭塞。在左回旋支进行经皮冠状动脉介入治疗（PCI）。随后的血管造影显示最佳的支架定位，没有血肿或夹层的证据。按照程序，患者的胸痛和劳力性呼吸困难症状得到缓解，这导致了他随后的出院。随访心电图,手术后10个月，显示缓慢且有规律的心房节律。
结论：右位心的发生率很低，它可能在心电图上看起来正常；然而，当肢体导线中P波方向异常时，需要仔细诊断。在右侧冠状动脉慢性闭塞性病变的手术中，异常解剖结构需要对仪器选择和手术技术的具体要求。右位心慢性闭塞血管血运重建后，常规心电图检查可能显示假正常化，在解释时需要谨慎。
方法：一名男性汉族患者，51，被录取了，在过去的一周中出现反复发作的胸痛，最近出现劳力性疲劳。他报告说，在过去的一年里，身体活动后出现了胸痛，持续5至20分钟。尽管有这些症状,病人没有立即就医，他的胸痛在一年内逐渐减轻。一周前,患者在短暂散步后出现劳力性呼吸困难，尽管没有任何夜间阵发性呼吸困难的发作。一到达我们医院接受评估，他最初被诊断出患有慢性冠状动脉综合征，先前的下壁心肌梗死，房性心律失常,并归入纽约心脏协会功能等级III。在他承认之后,进行了胸部X线和冠状动脉造影.结果表明镜像右位心和左回旋支完全闭塞。在左回旋支进行经皮冠状动脉介入治疗（PCI）。随后的血管造影显示最佳的支架定位，没有血肿或夹层的证据。按照程序，患者的胸痛和劳力性呼吸困难症状得到缓解，这导致了他随后的出院。随访心电图,手术后10个月，显示缓慢且有规律的心房节律。
结论：右位心的发生率很低，它可能在心电图上看起来正常；然而，当肢体导线中P波方向异常时，需要仔细诊断。在右侧冠状动脉慢性闭塞性病变的手术中，异常解剖结构需要对仪器选择和手术技术的具体要求。右位心慢性闭塞血管血运重建后，常规心电图检查可能显示假正常化，在解释时需要谨慎。
