Primary PCI for acute myocardial infarction in a patient with situs inversus totalis and dextrocardia.

Situs inversus totalis with dextrocardia is a rare congenital occurrence. Risk of coronary atherosclerosis and acute myocardial infarction in this subset is similar to that in the general population. Diagnosing myocardial injury in time, and executing primary percutaneous coronary intervention (PCI) successfully in these patients is challenging given that physicians are rarely attuned to recognizing the electrocardiographic changes of acute coronary syndromes in this anatomy and interventional cardiologists are not routinely accustomed to working with the angiographic projections in this unique subset. Here, we describe electrocardiogram identification and an approach to primary PCI in one such patient. We have also attempted to simplify and refine primary PCI in this subset by introducing postero-anterior projection single inversion technique for suitable lesions in suitable vessels in this unique subset. <Learning objective: Angioplasty of a diseased left anterior descending artery (LAD) in situs inversus dextrocardia can be simplified by using the postero-anterior (PA) projection predominantly, [thus eliminating the need for the need for right anterior oblique/left anterior oblique swapping (the reverse technique)], and utilizing only right-left reversal by activating horizontal sweep reverse option while filming the proximal (caudal tilt) and distal LAD (cranial tilt) to reorient the vessel in a viewer friendly equivalent. This we called the PA projection-single inversion technique for LAD in situs inversus dextrocardia.>.