Background: Dextrocardia with situs inversus is a rare congenital anomaly where the heart and abdominal organs are mirrored. Coronary artery disease (CAD) in these patients occurs at a similar rate as in the general population, but surgical management requires modifications due to anatomical differences. Aim: To discuss the technical considerations and execution of off-pump coronary artery bypass grafting (OPCABG) using bilateral internal mammary arteries (BIMA) in a dextrocardia patient. Case Presentation: A 48-year-old male with chest pain for one week was diagnosed with dextrocardia and CAD. ECG showed ischemic changes, and echocardiography revealed mid-basal inferior and inferolateral wall hypokinesia. Coronary angiography demonstrated total LAD occlusion with retrograde RCA filling and significant RCA stenosis. OPCAB was performed via median sternotomy, using BIMA for total arterial revascularization. RIMA was grafted to the LAD, and LIMA to the RCA, ensuring optimal exposure and graft positioning. Conclusion: Surgical intervention in dextrocardia requires tailored techniques. The left-sided operating position enhances exposure, and BIMA use improves long-term outcomes. Meticulous preoperative planning and intraoperative modifications can lead to successful CABG in these complex cases.
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