Kansas City, Missouri, USA

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Presentation transcript:

Kansas City, Missouri, USA CASE PRESENTATION Barry D. Rutherford, MD Kansas City, Missouri, USA CRT 2012

50-Year-Old Male Case Presentation History: Oct 2011: Presented to local hospital with dyspnea, chest pain, pulmonary congestion, edema, BNP 600, Creatinine 1.7 Risk Factors: Hypertension; Diabetes – 20 yrs, Renal Insufficiency; Heavy cigarette intake – 2 pk/day for 30+ yrs Exam: 6’1”, 163 lbs, BP 160/90, S3 and S4 gallop, bilateral rales Meds: ASA 325 qd, Ibuprofen 200 mg 4X qd, Lisinopril 10 mg qd; Furosemide 40 mg qd; Metformin HCl 500 mg bid EKG: NSR, LVH, anterior repolarization abnormality Cardiac MR LVEF 30%, Basal-to-mid lateral akinesis and basal-to-mid anterior/anteroseptal akinesis Viability: Anterolateral/inferolateral subendocardial infarct (<25%) Anteroseptal/subendocardial infarct (<25%) All walls are viable. Cor. Angio: 11-10-2011

50-Year-Old Male 11-10-11 CTO of RCA and Functional CTO of LAD

50-Year-Old Male CTO of RCA and Functional CTO of LAD Treatment Options: Continued medical therapy CABG Percutaneous intervention Method of approach: RCA, LMCA, LAD

50-Year-Old Male CTO of RCA and Functional CTO of LAD Surgical Opinion: “graftable acute marginal branch… …unlikely that we would be very gratified with grafts to the LAD or distal RCA. Furthermore, in conjunction with his severe LV dysfunction and fairly diseased vessels, it is unlikely that he would have significant myocardial recovery…” “…may benefit from high risk stenting to the LMCA to improve flow the LCX marginal branch” SURGICAL TURNDOWN

50-Year-Old Male 12-13-11 CTO of RCA and Functional CTO of LAD Surgical Turndown LVEF 20%

50-Year-Old Male CTO of RCA and Functional CTO of LAD Prox LAD Mid LAD

50-Year-Old Male 1-26-12 CTO of RCA and Functional CTO of LAD Surgical Turndown LVEF 20%

50-Year-Old Male CTO of RCA and Functional CTO of LAD 12/13/11: Stenting of LMCA and LAD: 3.0x28, 2.75 x 28 and 2.5x20 Promus DES Procedure time 120 min, Fluoro time 59.9 min, 4 Gy, Contrast load 500 cc’s Creatinine 12/14/11: 1.9 1/24/12: Readmitted for PCI to RCA; Creatinine 2.4; Clinically improved, no LVF 1/26/12: Creatinine: 1.9 with hydration Stenting of RCA: 2.75x28, 3.0x28, 3.5x28 and 3.5x18 Promus DES Procedure time 115 min, Fluoro time 42.7 min, 3 Gy, Contrast load 90 cc’s