Case presentantion 73-year old female

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Presentation transcript:

Successful PCI of left main coronary artery caused by pulmonary artery dilatation presenting as ACS

Case presentantion 73-year old female treated for idiopatic pulmonary arterial hypertension since 2006, coronary angiography 2006 without stenosis no other significant medical history Medication: verapamil 240mg 1-0-0, bosentan 125mg 1-0-1, sildenafil 20mg 1-1-1, furosemide 40mg 1-0-0, selexipag (oral, selective prostacyclin receptor agonist – study drug) 8-0-8, warfarin 3mg 1-0-0 was admitted at 10 AM to our hospital for acute chest pain with dyspnoe since 7 AM Physical examination : BP 130/80 mmHg, heart rate 69/min, systolic murmur parasternal right, mild perimaleolar oedema

Case presentation Laboratory results Electrocardiography troponin I 0.445 μg/l (cut-off for AMI 0.3), INR 2.03 Electrocardiography sinus rhytm, incomplete right bundle branch block, ST depression 1mm I,aVL,V5-6 Echocardiography non-dilated left ventricle, paradoxical septal movement, mild anterolateral hypokinesis right ventricular dilatation and hypertrophy, moderete tricuspid regurgitation, pulmonary hypertension (calculated sTK 90mmHg) Coronary angiography at 11 AM via radial artery 6 F sheat (Terumo), diagnostic catheter Tiger (Terumo)

Coronary angiography Severe stenosis of left main coronary artery (90%), no other significant stenosis, codominant system of heart circulation. Heart team decided to perform PCI.

Percutaneous coronary intervention Preventive placement of intra-aortic ballon conterpulsation via right femoral artery, 6F guiding catheter XB3.5 (Cordis), two Advance wires (Abbott), direct implantation of Biomatrix 3,5/14mm stent (Biosensors) from left main to left anterior descending artery with final „kissing“ with two 3,5/10 mm baloons.

Case presentantion After PCI she was without pain. No occurred complication. Maximal value of troponin I was 7.233 µg/l. She was discharged from hospital after 6 days. Computed coronary angiography showed patent stent in the left main coronary artery, dilatation and hypertrophy of right ventricle and dilatation of pulmonary artery (40x52mm). At follow up the patient was symtomatic with stable dyspnoe (III. grade of functional class), no angina, computed tomography was performed after 6 and 16 months without significant restenosis or compression of the stent in the left main coronary artery.

Computed coronary angiography August 2012 December 2013 (Ao – aorta, AP – pulmonary artery, LV – left ventricle)

Critical stenosis of left main coronary artery caused by dilated pulmonary artery is a rare, but serious complication of pulmonary arterial hypertension. Treatment with drug-eluting-stent is feasible with safe mid-term follow up.