IJCS | Volume 33, Nº2, March / April 2020

DOI: 10.5935/2359-4802.20190022 192 CASE REPORT International Journal of Cardiovascular Sciences. 2020; 33(2):192-196 Mailing Address: Igor André Telles da Cunha Rua Ivo Borgs, 175, bl.: 2, ap.: 203. Postal Code: 22790-440, Recreio dos Bandeirantes, Rio de Janeiro, RJ - Brazil. E-mail: cantanhedaclaudia@gmail.com, igortellescunha@gmail.com Coronary Artery Disease Associated with Coronary Anomaly and Situs Inversus Totalis in Man Submitted to Angioplasty Alexandre Fuchs, 2 Leandro Bonecker Lora, 1 J oão Renato Cardoso Mourão, 1 F ernando César da Costa Duarte, 1 Igor André Telles da Cunha, 1 C laudia Regina de Oliveira Catanheda 2 Universidade Unigranrio, 1 Duque de Caxias, RJ - Brazil Instituto Estadual de Cardiologia Aloysio de Castro (IECAC), 2 Rio de Janeiro, RJ - Brazil Manuscript received June 04, 2018; revised manuscript July 27, 2018; accepted September 09, 2018. Coronary Diseases/complications; Dextrocardia; Situs Inversus; Heart Defects, Congenital;Angioplasty,Balloon, Coronary; Stent; Thromboytic Terapy. Keywords Introduction Dextrocardia associated with situs inversus totalis is a rare condition with an incidence of 1:10,000 in the general population. 1,2 It is characterized by a complete left-to-right reversal of the abdominal organs, including the abnormal position of the heart, resulting fromchanges in embryological development during the gastrulation stage (third week), characterized by the establishment of the craniocaudal, dorsoventral and right-left axes in the embryo. This condition is transmitted by autosomal recessive genes, located in the long arm of chromosome 14, which affects the genetic cascade responsible for left-right differentiation. It should be noted that most affected individuals can have normal lives. 3 The association of situs inversus totalis with coronary atherosclerotic diseases have similar incidence to the general population. However, the surgical approach in an event of acute infarction has significant statistical difference, since in patients with the anatomical conditionmentioned before, there are more reports in the literature of myocardial revascularization surgery than percutaneous coronary intervention. 4 The exceptional nature of the case was more evident after the coronary angiography showed right coronary artery originating from the left coronary sinus and anomalous pathway, which is a rare congenital coronary anomaly. Coronary artery anomalies can be found in 0.3% to 5.6% of the population. 5 Congenital changes are associated with early morbidity and mortality in young adults, and there are reports of sudden deaths either during or after extenuating physical activity. 6 It is estimated that this is the second more frequent cause of sudden death of cardiovascular origin among athletes, occurring between 12.2% to 17.2% in Europe and in the United States and dividing expert opinion, especially in regards with the therapeutic approach. 7 Case report A 46 year-old white male patient, natural from Rio de Janeiro, previously healthy, with a Framingham score of 11.7% (dyslipidemia, previous history of CAD) and dextrocardia associated with situs inversus totalis, reported that in September 2017 he started with dyspnea to medium efforts, which subsequently evolved to small efforts. On October 14, 2017, when he was making physical effort while repairing his house, he started with oppressive chest pain radiating to interscapular region associated with dyspnea and palpitation. Thus, he went to the emergency care unit, where he had a syncopal episode. Laboratorial tests were performed and the results showed positive myocardial necrosis markers, with a significant curve and a peak CK-MB 17.4 ng/mL and a troponin of 0.6 ng/mL. He was diagnosed with acute ST-segment elevation myocardial infarction (STEMI), presenting reperfusion criteria, and treated with thrombolytic therapy. He was transferred to the State Institute of Cardiology Aloysio de Castro (IECAC), on October 16, 2017, where he underwent coronary angiography, which showed a severe 90% (ninety percent) lesion in the proximal