A 73 year-old man, with known situs viscerum inversus, symptomatic for effort dyspnea, was admitted to our Department for inducible myocardial ischemia. Coronary angiography showed severe narrowings of the distal right coronary artery, treated by percutaneous coronary intervention and drug eluting stents implantation. Percutaneous coronary intervention was performed using standard diagnostic and guide catheters, requiring opposite manipulation and inverted angiographic projections.