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Off-pump coronary artery bypass in poland syndrome with dextrocardia: case report
© Srivastava et al; licensee BioMed Central Ltd. 2011
Received: 13 March 2011
Accepted: 18 May 2011
Published: 18 May 2011
Poland Syndrome is a congenital disorder characterised by hypoplasia of the pectoral muscles along with upper extremity deformities. We encountered a patient with Poland syndrome associated with dextrocardia and also failed pectus excavatum repairs who presented to us with symptomatic ischaemic heart disease requiring intervention. He underwent successful off-pump coronary artery bypass surgery (OPCABG). As far as we are aware, this is the first case report of OPCABG in a case of Poland syndrome with dextrocardia. We describe here the management of this complex patient and wish to emphasise that the off-pump option is feasible in dextrocardia with some technical modifications.
KeywordsCoronary artery bypass graft surgery CABG Off-pump surgery OPCAB Pectus excavatum Poland Syndrome
Off-Pump Coronary Artery Bypass in Poland syndrome with dextrocardia: Case Report
Poland syndrome (PS) is a rare congenital disorder with an incidence of 1 in 7,000 to 1 in 100,000  characterized by hypoplasia of the pectoral muscles with associated upper extremity deformities. The anomalies in PS are attributed to hypoplasia of the subclavian artery or its branches as the result of an in-utero vascular accident [2, 3]. Dextrocardia is an associated anomaly and has been reported in 5.6% cases of a series of 144 and in 9.6% of these, the defect was left-sided . We encountered a case of left sided Poland syndrome associated with dextrocardia who presented to us with coronary artery disease and successfully underwent off-pump coronary artery bypass grafting (OPCABG).
Ailiwadi et al  have previously reported coronary artery bypass in a patient with Poland syndrome and demonstrated normal flow through the left internal mammary artery (LIMA) before using it as a conduit. In a recent article, Saad et al  reviewed coronary artery bypass in dextrocardia. They found 10 off-pump cases while 14 cases used cardiopulmonary bypass. In 16 of the 24 cases, the RIMA was grafted to the LAD. Surgery was performed from the right side in 5 cases and from the left in 10. The surgeon needed to switch sides in 3 cases. To our knowledge, ours is the first report of OPCABG in a case of Poland syndrome with dextrocardia and only the second case report of coronary artery bypass in Poland syndrome. Any concerns about an insufficient LIMA were addressed by use of RIMA. Surgery was further facilitated by a change in the surgeon's position. We wish to emphasise that OPCABG is a feasible option in patients with dextrocardia and adequate revascularisation can be achieved with planning and certain technical modifications.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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