A case of percutaneous coronary intervention of the right coronary artery in a situs inversus patient with foreshortening of lesion revealed by intravenous ultrasound imaging technology

Situs inversus totalis is a rare anomaly in which the internal organs are transposed oppositely as mirror images. Due to its rarity, interventionalists are less likely to be acquainted with angiography in this unique population. In the case of lesion ambiguity, different invasive diagnostic tools can be used to further evaluate lesion severity, including fractional flow reserve, instantaneous wave-free ratio and intravenous ultrasound (IVUS). In this case, we discuss the usefulness of IVUS as a beneficial tool in evaluation of angiographically ambiguous lesions due to foreshortening. Dextrocardia presents unique challenges to the interventional cardiologist secondary to difficulty in acquiring adequate views and unfamiliarity with mirroring of anatomy, and thus angiography can result in inaccurately assessed lesions. We demonstrate how IVUS can be used in evaluation of such lesions for more accurate evaluation, precision in stent placement and in turn better patient outcomes.