Case of RCA CTO of a patient with low left ventricular function with ...

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Case of RCA CTO of a patient with low left ventricular function with two-branch-occlusion in LCx and RCA

Makoto Kadotani,MD., Ph.D Kakogawa East City Hospital, Japan

53y/o,Male

C.C : Chest discomfort on effort P.H : Hypertension, Dyslipidemia, Diabetis Mellitus P.I : He was admitted to our hospital last year for congestive heart

failure and received treatment. Cardiac catheterization was done to investigate the underlying cause. Findings: LVG; diffuse hypokinesis~severe hypokinesis EF 30% CAG;RCA#2 100% occ(collateral from LAD), LAD#7 90%, LCx#13 100% occ (collateral from LAD)

PCI to LAD was done in December 2011. PCI for RCA CTO in December 2011 and LCx CTO in March 2012. GW could not cross in either of the cases and both ended in failure. The patient was admitted to our hospital for treatment of RCA CTO.

Kakogawa East City Hospital

ECG

Normal Sinus Rhythm,HR 79bpm,IaVLV5,6 ST depression

Kakogawa East City Hospital

ChestXp

Laboratory Data

CTR49.7%,No Congestion

WBC 11.5 ? 103/l CPK 191 IU/l

RBC 4.90 ? 103/l BUN 20.3 mg/dl

Hb

15.1 mg/dl

Cr 0.95 mg/dl

Ht

43.9 %

Na 136 mEq/l

MCV 89.6 fl

K 4.8 mEq/l

MCH 30.8 pg

Cl 98 mEq/l

MCHC 34.4 %

PLT 19.7 ? 104/l eGFR 65.7 ml/min/1.73m

TP T-Bil LDH GOT GPT

7.3 g/dl 0.4 mg/dl 158 IU/l 29 IU/l 56 IU/l

glucose 247 T-cho 255 HDL-C 37 TG 318 LDL 157 HbA1c 9.0

mg/dl mg/dl mg/dl mg/dl mg/dl %

Kakogawa East City Hospital

LVG(12/21/2011)

RAO30?

LAO45?

Diffuse severe Hypokinesis EF 30% EDVI 209.7

Kakogawa East City Hospital

CAG(12/21/2011)

Mid LAD 90%

90%

Proxiaml LCx 100%occ Poor collateral from

100%occ Fai collateral from septal

branch

High lateral branch

Kakogawa East City Hospital

PCI for LAD(12/21/2011)

Mid LAD 90%

3.0x28mm XienceV

Pre

Post

GC:Britetip XB3.5 6Fr

GW:Neos Route,Kinetix Balloon3x15mmNC TREK,2.0x15mmTREK

Kakogawa East City Hospital

PCI for RCA CTO (10/3/2012)

Proximal RCA 90%

RAO30? CAU15?

CLRAAO304?5?

Mid RCA 100%occ

GCLaIntcwhaeGsrCe8xFcrLh.aAannLgce1Pahdtreo#trom38UuFslrt#Ei.P4mElAoeBXwaVsmttiaUeeesaCBn3nndrrc.td5eoue2pPsSsa.3hl5RHnogxosyI1tMtee6hdnmeEtar2imtn.5#gPwx3r3ao8smm#du1me.spElaolnyedmed3e.n0tx38mm which mRaeCnRvoaIoeergVrfvsesea#Ude2ri4rSs.tAC5&eowVxACpS2aaeI8ARsOnnmRuTedNmstTreGadaAtteIo#Ath3che2enCdc#kT4wPOtahDs.eifnossretirCutremudsh stenting.

LAO45? CRAtIo0u#?s4eAdVthues3inrdg sCeoprtsaal ibr.ranch.

Kakogawa East City Hospital

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