# Flipping the Script: Pharmacologic Myocardial Perfusion Imaging and Percutaneous Coronary Intervention in a Patient With Dextrocardia and Situs Inversus Totalis

## TL;DR

A 74-year-old woman with rare heart and organ reversal underwent successful heart procedures despite anatomical challenges.

## Contribution

This case highlights procedural adaptability in coronary interventions for patients with dextrocardia and situs inversus totalis.

## Key findings

- Pharmacologic MPI revealed a lateral wall perfusion defect and preserved ejection fraction.
- PCI was successfully performed via femoral access despite mirrored coronary anatomy.
- The case emphasizes the need for anatomical awareness and imaging expertise in such rare conditions.

## Abstract

Situs inversus totalis (SIT) is an extremely rare congenital abnormality in which the positions of the body’s organs are mirrored. It can be accompanied by dextrocardia, where the heart is located in the right thorax with its apex pointing to the right side of the body. Its rarity poses diagnostic and therapeutic challenges, particularly in patients with coronary artery disease (CAD). We report the case of a 74-year-old woman who presented with dyspnea. Her medical history included hypertension, diabetes mellitus, hypothyroidism, and dextrocardia with SIT, incidentally diagnosed at age 45 following two cerebrovascular accidents.

She underwent pharmacologic myocardial perfusion imaging (MPI) with 99mTc-MIBI and adenosine, which revealed mild-to-moderate left ventricular dilation; a medium-sized, moderate-intensity lateral wall perfusion defect during stress; partial lateral wall redistribution at rest; and a preserved left ventricular ejection fraction of 89%. Subsequent left and right heart catheterization (LHC and RHC) and percutaneous coronary intervention (PCI) were performed via femoral access, with successful stent deployment despite the mirrored coronary anatomy. This case underscores the importance of anatomical awareness, imaging interpretation skills, and procedural adaptability when performing coronary interventions in patients with SIT and dextrocardia.