Off-Pump Triple Coronary Artery Bypass Grafting in a Patient with Situs Inversus Totalis: Case Presentation and a Brief Review of the Brazilian and the International Experiences

Karigyo, Carlos Junior Toshiyuki; Batalini, Felipe; Murakami, Alexandre Noboru; Teruya, Rogério Toshio; Gregori Júnior, Francisco

doi:10.5935/1678-9741.20160021

Carlos Junior Toshiyuki Karigyo Correspondence Address: Carlos Junior Toshiyuki Karigyo, Department of Cardiac Surgery at Hospital Regional João de Freitas, Rodovia PR 218, Km 01, s/n - Jardim Universitário - Arapongas, PR, Brazil, Zip code: 86702-670. E-mail: ctkarigyo@hotmail.com

Department of Cardiac Surgery at Hospital Regional João de Freitas, Arapongas, PR, Brazil.

Felipe Batalini

Department of Internal Medicine at Boston University Medical Center, Boston, United States.

Alexandre Noboru Murakami

Department of Cardiac Surgery at Hospital Regional João de Freitas, Arapongas, PR, Brazil.

Rogério Toshio Teruya

Department of Cardiac Surgery at Hospital Regional João de Freitas, Arapongas, PR, Brazil.

Francisco Gregori Júnior

School of Medicine at State University of Londrina, Londrina, PR, Brazil.

Correspondence Address: Carlos Junior Toshiyuki Karigyo, Department of Cardiac Surgery at Hospital Regional João de Freitas, Rodovia PR 218, Km 01, s/n - Jardim Universitário - Arapongas, PR, Brazil, Zip code: 86702-670. E-mail: ctkarigyo@hotmail.com

Figures (2)
Tables (4)

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Fig. 1
(A) Preoperative chest roentgenogram showing dextrocardia. (B) Abdominal CT demonstrating situs inversus totalis. (C) Coronary angiography. (D) Intraoperative view after complete revascularization.

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Fig. 2
Postoperative CT angiography indicating (A) RIMA anastomosed to the LAD artery (arrow); (B) Saphenous vein grafted to the PDA (arrow); (C) three dimensional front view and (D) lateral view.

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Abbreviations, acronyms & symbols BIMA = Bilateral mammary arteries CAD = Coronary artery disease CPB = Cardiopulmonary bypass CT = Computed tomography LCA = Left main coronary artery LIMA = Left internal mammary artery PDA = Posterior descending artery RIMA = Right internal mammary artery

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Table 1
The Brazilian experience with coronary artery bypass grafting in a patient with situs inversus totalis.

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Table 2
The international experience with coronary artery bypass grafting in a patient with situs inversus totalis.

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Authors' roles & responsibilities CJTK Conception and design study; realization of operations and/or trials; analysis and/or data interpretation; manuscript redaction or critical review of its content; final manuscript approval FB Manuscript redaction or critical review of its content; final manuscript approval ANM Realization of operations and/or trials; final manuscript approval RTT Realization of operations and/or trials; final manuscript approval FGJ Final manuscript approval

Abbreviations, acronyms & symbols
BIMA	= Bilateral mammary arteries
CAD	= Coronary artery disease
CPB	= Cardiopulmonary bypass
CT	= Computed tomography
LCA	= Left main coronary artery
LIMA	= Left internal mammary artery
PDA	= Posterior descending artery
RIMA	= Right internal mammary artery

Authors	Year	Age (years)	Gender	Disease	Distal anastomosis	Grafts	Pump	Surgeon side
Karigyo et al.	present	76	M	3VD	3	RIMA, Saphenous vein	Off	Left
Saadi et al.^[⁴4 Saadi EK, Dussin LH, Nicolao A, Zago AJ. Coronary artery bypass grafting in a patient with situs inversus totalis and dextrocardia. Rev Bras Cir Cardiovasc. 2007;22(3):346-8.^]	2007	78	F	3VD^* * Presence of aneurysms in the left descending coronary artery	3	RIMA, Saphenous vein	On	Left
Pêgo-Fernandes et al.^[³3 Pego-Fernandes PM, de Serro-Azul JB, Matheus F, Maehara BS. Myocardial revascularization in a patient with situs inversus totalis. Arq Bras Cardiol. 2007;88(5):e103-6.^]	2007	63	M	5VD	5	RIMA, Saphenous vein	On	Left
Rosa et al.^[²2 Rosa GRS, Lemke VG, Lemke W, Madeira Neto J, Martins AAF, Kubrusly LF. Myocardial revascularization in patient with situs inversus totalis: case report. Rev Bras Cir Cardiovasc. 2002;17(4):359-61.^]	2002	53	F	1VD (LCA)	3	RIMA, Saphenous vein	On	Left
Abensur et al.^[¹1 Abensur H, Ramires JA, Dallan LA, Jatene A. Right mammary-coronary anastomosis in a patient with situs inversus. Chest. 1988;94(4):886-7.^]	1988	38	M	1VD	1	RIMA	On	Not mentioned

Authors	Year	Country	Age (years)	Gender	Disease	Distal anastomosis	Grafts	Surgeon side
Tabry et al.^[⁶6 Tabry IF, Calabrese J, Zammar H, Abou-Kasem K, Akeilan H, Gharbieh N, et al. Case report: off-pump total myocardial revascularization for dextrocardia and situs inversus. Heart Surg Forum. 2001;4(3):251-3.^]	2001	USA	42	M	3VD	4	BIMA, Saphenous vein	Left
Stamou et al.^[⁷7 Stamou SC, Bafi AS, Kapetanakis EI, Lowery RC, Pfister AJ, Dullum MK, et al. Beating heart surgery in a patient with dextrocardia and complete situs inversus. J Card Surg. 2003;18(2):170-2.^]	2003	USA	65	F	2VD	2	RIMA, Saphenous vein	Both
Bonde & Campalani^[⁸8 Bonde P, Campalani GF. Myocardial revascularization for situs inversus totalis and dextrocardia. Interact Cardiovasc Thorac Surg. 2003;2(4):486-8.^]^* * Conversion to on-pump technique due to hemodynamic instability	2003	UK	82	M	2VD	2	RIMA, Saphenous vein	Left
Bonanomi et al.^[⁹9 Bonanomi G, Kostov D, Zenati MA. Emergent off-pump complete myocardial revascularization in dextrocardia. J Cardiovasc Surg (Torino). 2004;45(1):31-3.^]	2004	USA	72	F	2VD	2	RIMA, Saphenous vein	Not mentioned
Abdullah & Mazalan ^[¹⁰10 Abdullah F, Mazalan SL. Off-pump coronary artery bypass grafting in a high-risk dextrocardia patient: a case report. Heart Surg Forum. 2004;7(3):E186-8.^]	2004	Malaysia	56	M	3VD	3	Saphenous vein	Right
Kuwata et al.^[¹¹11 Kuwata T, Kawata T, Ueda T, Sakaguchi H, Nagasaka S, Taniguchi S. Off-pump quintuple coronary artery bypass grafting for situs inversus totalis. Jpn J Thorac Cardiovasc Surg. 2004;52(10):473-5.^]	2004	Japan	49	M	3VD	5	BIMA, Radial artery	Left
Ennker et al.^[¹²12 Ennker IC, Pietrowski D, Ennker J. Off-pump myocardial revascularisation in an octogenarian patient with dextrocardia and situs inversus. Cardiovasc J S Afr. 2006;17(5):257-8.^]	2006	Germany	82	F	unknown	2	RIMA	Left
Chakravarthy et al.^[¹³13 Chakravarthy M, Jawali V, Nijagal D. Off-pump coronary artery bypass surgery in dextrocardia: a report of two cases. Ann Thorac Cardiovasc Surg. 2008;14(3):187-91.^]	2008	India	41	M	3VD	2	LIMA, Radial artery, Saphenous vein	Right
Chakravarthy et al.^[¹³13 Chakravarthy M, Jawali V, Nijagal D. Off-pump coronary artery bypass surgery in dextrocardia: a report of two cases. Ann Thorac Cardiovasc Surg. 2008;14(3):187-91.^]	2008	India	81	M	3VD	3	RIMA, Saphenous vein	Both
Yamashiro et al.^[¹⁴14 Yamashiro S, Iha K, Akasaki M, Uezu T, Ikemura R, Nishijima I. Emergency off-pump complete arterial revascularization in a patient with dextrocardia. Gen Thorac Cardiovasc Surg. 2009;57(11):625-8.^]	2009	Japan	73	M	3VD	3	BIMA, Radial artery	Right
Romano et al.^[¹⁵15 Romano G, Guida G, De Garate E, Guida MC. Minimally-invasive coronary surgery in dextrocardia and situs inversus totalis. Interact Cardiovasc Thorac Surg. 2010;11(6):820-1.^]^‡ ‡ Minimally invasive technique	2010	Italy, Venezuela	59	F	1VD	1	RIMA	Right
Arrigoni et al.^[¹⁶16 Arrigoni SC, Oosterhof R, Mariani MA. Off-pump Y-graft coronary artery bypass in a patient with situs inversus totalis. Interact Cardiovasc Thorac Surg. 2010;11(6):822-4.^]	2010	The Netherlands	67	M	3VD	3	RIMA, Radial artery	Left
Takahashi et al.^[¹⁷17 Takahashi H, Okada K, Matsumori M, Okita Y. Off-pump coronary artery bypass grafting in an octogenarian with situs inversus and dextrocardia: report of a case. Surg Today. 2011;41(8):1130-2.^]	2011	Japan	83	M	3VD	3	BIMA, Saphenous vein	Right
Mouline & Vallely ^[¹⁸18 Mouline O, Vallely MP. Total arterial off-pump coronary artery bypass in a patient with situs inversus and dextrocardia. Eur J Cardiothorac Surg. 2013;43(4):e101.^]	2013	Australia	81	M	1VD	2	BIMA	Not mentioned
Su et al.^[¹⁹19 Su PX, Gu S, Liu Y, Gao J. Partial sternotomy coronary surgery with triple-vessel disease in dextrocardia and situs inversus totalis. Interact Cardiovasc Thorac Surg. 2013;17(1):213-5.^]^‡ ‡ Minimally invasive technique	2013	China	65	F	3VD	3	RIMA, Saphenous vein	Both

Authors' roles & responsibilities
CJTK	Conception and design study; realization of operations and/or trials; analysis and/or data interpretation; manuscript redaction or critical review of its content; final manuscript approval
FB	Manuscript redaction or critical review of its content; final manuscript approval
ANM	Realization of operations and/or trials; final manuscript approval
RTT	Realization of operations and/or trials; final manuscript approval
FGJ	Final manuscript approval

[1] Correspondence Address: Carlos Junior Toshiyuki Karigyo, Department of Cardiac Surgery at Hospital Regional João de Freitas, Rodovia PR 218, Km 01, s/n - Jardim Universitário - Arapongas, PR, Brazil, Zip code: 86702-670. E-mail: ctkarigyo@hotmail.com

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Off-Pump Triple Coronary Artery Bypass Grafting in a Patient with Situs Inversus Totalis: Case Presentation and a Brief Review of the Brazilian and the International Experiences

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