CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 2, May – August 2024 AFRICA 129 The primary dispute in the medical literature concerning CABG for patients with dextrocardia involves the standing position of the operating surgeon, to the left or right side of the patient during the operation. In our case, the surgeon anastomosed the LAD and diagonal-1 arteries while standing on the right side, which is the typical surgical position. However, the LCx artery was anastomosed while standing on the left side, which is opposite to the usual surgical standing position. To the best of our knowledge, this case is the 38th reported dextrocardia CABG case in the medical literature.3 Conclusion Cross-sectional imaging with CT is a valuable method in the evaluation of anatomical relationships. In this case with situs inversus and dextrocardia, a cardiac CT scan clearly demonstrated the mirror-image location of the intra-abdominal solid organs, cardiac cavity and coronary arteries. With the current technological developments, critical stenosis in the coronary arteries can be detected with CCTA examination. CT imaging can serve as a detailed roadmap by visualising the variable anatomy and coronary artery locations, ostia and stenosis in SIT. With the use of volume-rendered threedimensional and curved reformatted images reconstructed from CCTA, the advance of catheters and guidewires during invasive coronary angiography and planning of surgical procedures can be performed more safely. References 1. Wolla CD, Hlavacek AM, Schoepf UJ, Bucher AM, Chowdhury S. Cardiovascular manifestations of heterotaxy and related situs abnormalities assessed with CT angiography. J Cardiovasc Comput Tomogr 2013; 7(6): 408–416. 2. Maldjian PD, Saric M. Approach to dextrocardia in adults: review. Am J Roentgenol 2007; 188(6 Suppl): S39–49; quiz S35–38. Fig. 3. A. Curved reformatted images of the left coronary artery showing extension of high grade stenosis from the distal left main coronary artery to the left anterior descending artery (white arrow). B. Invasive coronary angiography of the right cranial image of our patient (typically a standard left cranial image of a normal patient). A B Fig. 4. CABG with full venous grafts.
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