Percutenous transemitral commsurotomy in patients with mirror image Dextrocardia can be confusing to operator. Recently we had a patient with Dextrocardia with situs inverses with severe mitral stenosis. We did PTMC.
We googled the net and came across the similar case reports. Most articles described this procedure as to take puncture on left side of thigh and to invert right to left image of cathlab machine. Septal descent was done in AP view. Instead of RAO and lateral view for septal puncture LAO and lateral view were used. Pointer of septal puncture needle is to be directed to 7 O clock instead of 5 O clock.
We initially did plan same as described by others, but our cathlab machine did not have inversion of right to left image facility so we had go ahead with conventional imaging without inversing. We used LAO instead of RAO. We held marker of puncture needle at 7 O clock instead of 5 O clock as described by others. We could easily puncture and do the procedure without much problem.
We felt that image inversion of right to left by cathlab machine is not required as it may lead much more confusion for imagination as we got inverse our thinking process twice.
We recommend not to inverse the cathlab machine image for doing PTMC in Dextrocardia with Situs inverses