Under the Dynamic leadership of our Director Dr.C.N.Manjunath Professor & Head of the Department of Cardiology, Sri.Jayadeva Institute of Cardio Vascular Sciences & Research, Bangalore a unique & rare Surgery was performed.

A 53 year old female patient from Mysore underwent successful Off Pump CABG surgery for Coronary artery disease with instent stenosis in a rare cardiac anomaly called  Dextrocardia with SitusInversusTotalis with respiratory problems? Kartagener’s Syndrome who had earlier undergone PTCA .

The surgery was performed by Dr. Venugopal Ram Rao, Professor & Unit Head in Cardiac Surgery and his team consisting of Dr. Sunil, Dr.Madhusudhan, Dr.Rashmi, Dr. Vineeth, Dr.Bharath and Dr.Bhagyashree, and .the Anaesthetic team of Dr.Manjunath, and Dr.Parimala assisted. Dr. Raghu, Professor & Unit Head , Cardiology evaluated.He had performed PTCA 8 yrs back. She also had uncontrolled Diabetes Mellitus and Hypothyroidism.

Dextrocardia with SitusInversusis a condition in which the organs of the chest and abdomenare arranged in a perfect mirror image reversal of thenormal positioning. Here the heart ,instead of being on the left side , is found on the right side, the liver is on the left side instead of right side of abdomen and the spleen and stomach on the right side , instead of left side. There is another anomaly called as Dextrocardia without SitusInversus. In Kartagener Syndrome, apart from Dextrocardia and SitusInversustotalis , patient also has respiratory problems involving Ciliary movement of the respiratory mucuosa.

The challenge in the surgery is  the position of the operating surgeon and rest of the surgical team. Conventional wisdom and majority of the literature says that most of the surgeries were performed from the left side. In our case, we could accomplish it with ease  from the right side itself. The CABG surgery can be done either On Pump or Off Pump and we happened to do it Off Pump.The other problem with this patient was her respiratory issues for which additional care and support was needed in the form of elective ventilation for a period of 12 hours, bronchodilator and steroid inhalers in the immediate post op period.

The first reported case of CABG with Dextrocardia was in the year ,1980. Only 32 cases have been reported in world literature and among these, only 3 cases have been reported from India. Among these, only 11 have undergone Off Pump CABG. Only 1 case has been reported  in world literature with Dextrocardia with SitusInversus with Kartagener Syndrome. To the best of our knowledge, this is the first reported case of Off Pump CABG in a case of Dextrocardia with SitusInversus with Kartagener Syndrome from India and second in the world literature.

Date: 17.1.14
(DR. VENUGOPAL RAM RAO)