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Lots of interesting abstracts and cases were submitted for TCTAP 2022. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!

TCTAP C-073

ECMO Assisted CHIP PCI for a Patient With Single Surviving Vessel With Moderate to Severe Calcified Disease With Severe Biventricular Dysfunction

By Nagendra Boopathy Senguttuvan, Harsimran Singh, Santhosh Kumar Periyasamy, Ramesh Sankaran, Vinod Kumar Balakrishnan, S Sadhanandham, Venkata Balasubramaniyan Jayanty, Preetam Krishnamurthy, Manokar Panchanatham, Thoddi Ramamurthy Muralidharan

Presenter

Nagendra Boopathy Senguttuvan

Authors

Nagendra Boopathy Senguttuvan1, Harsimran Singh2, Santhosh Kumar Periyasamy3, Ramesh Sankaran1, Vinod Kumar Balakrishnan1, S Sadhanandham1, Venkata Balasubramaniyan Jayanty1, Preetam Krishnamurthy1, Manokar Panchanatham1, Thoddi Ramamurthy Muralidharan1

Affiliation

Sri Ramachandra Institute of Higher Education and Research, India1, Pancham Hospital, India2, Sri Ramachandra Medical Center, India3,
View Study Report
TCTAP C-073
CORONARY - Complex and Higher Risk Procedures for Indicated Patients (CHIP)

ECMO Assisted CHIP PCI for a Patient With Single Surviving Vessel With Moderate to Severe Calcified Disease With Severe Biventricular Dysfunction

Nagendra Boopathy Senguttuvan1, Harsimran Singh2, Santhosh Kumar Periyasamy3, Ramesh Sankaran1, Vinod Kumar Balakrishnan1, S Sadhanandham1, Venkata Balasubramaniyan Jayanty1, Preetam Krishnamurthy1, Manokar Panchanatham1, Thoddi Ramamurthy Muralidharan1

Sri Ramachandra Institute of Higher Education and Research, India1, Pancham Hospital, India2, Sri Ramachandra Medical Center, India3,

Clinical Information

Patient initials or Identifier Number

2784128

Relevant Clinical History and Physical Exam

44-year-old female admitted with h/o breathlessness (NYHA III/IV) associated with abdominal distension.BP- 100/60 mmHg, PR- 100/minCVS- S1S2+, no murmurRS- B/L basal crepts +
PAST H/O :-•      Old inferior wall MI (DECEMBER 2020)•       S/P lysis with reteplase•       S/P CAG (January 2021) Mild Left main + triple vessel disease•       S/P Thrombo suction to RCA (January 2021) •       Recurrent heart failure•       TYPE II DM•       Hypothyroidism•       S/P right index and thumb amputation•       Severe PAH

Relevant Test Results Prior to Catheterization

2D TTE- Mildly dilated LV, bicuspid aortic valve, moderate TR with severe PAH (EPAP 72mmHg). Entire inferolateral and inferior wall, basal and mid anterolateral wall thinned and akinetic, apical anterior wall hypokinetic. Moderate to severe LV systolic dysfunction with grade III diastolic dysfunction (EF 32%). Moderate RV dysfunction (TAPSE 1.4cm).
ECG- NSR, no ST-T changes
C-MRI VIABLE LAD TERRITORY. MOST SEGMENTS OF RCA AND LCX ARE NOT VIABLE. 
Hb- 9.6 gm/dl
Creatinine- 0.9 mg/dl

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Relevant Catheterization Findings

CAG- TVD - Ostio proximal LAD moderately calcified with eccentric 80-90% disease.  - Ostioproximal LCX  70-80% lesion. Before bifurcating into OM3 & LPL1 circumflex has 80-90% disease. - RCA proximal - 60-70% lesion. dRCA- 50-60% lesion. PDA & PLB have diffuse disease.CATH STUDY- Pulmonary artery pressure- 72/32 mmHg- RA Pressure- 20 mmHgSYNTAX SCORE- 30
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Interventional Management

Procedural Step

Rt. femoral artery access secured with 8F sheath.Lt. femoral artery (FA) access secured with 15 F ECMO cannula and Lt. Femoral vein with 25 F ECMO cannula.Runthrough (Terumo, japan) wire crossed, IVUS planned. Sudden fall in the BP once IVUScatheter (OptiCross, Boston Scientific, USA) crossed into dLAD. IVUS aborted and ECMO initiated.Pre dilatation done in dLAD with 1.5x15 mm Sapphire Balloon (CSI, USA).Again after crossing IVUS catheter she developed bradycardia and hypotension. Quick manual pullback done - moderate to severe calcium arc of >200 degree in pLAD.Calcium modification done by using Shockwave C2 IVL balloon (ev3, USA).POBA TOdLAD done with 1.5x30 mm DEB (Concept Medical, Spain).IVUS 2 - Calcium was broken at multiple places after IVL.pLAD predilated with 3.5x10 mm AngioSculpt balloon (Philips, USA).[Using 2.75x28 mm DES  prox-mid LAD stented and 3.0x15 mm DES LM to pLAD stented] (Abbot, USA).LM POT done with 3.75x6 mm NC balloon (Terumo, Japan).With 3.25x10 mm NC balloon (Terumo, Japan), post dilatation done in distal LM. Using 3.0x10 mm NC balloon, post dilatation done in pLAD and mLAD.IVUS 3- Showed MSA of ostial LAD 6.12 mm2 (underexpanded stent).Post dilatation done with 3.5x10 mm OPN balloon (SIS medical, Switzerland).IVUS 4- showed MSA of mLAD 5.7 2mm2 and of ostial LAD 7.02 mm2.Ostial LAD post dilated again with OPN balloon.Final IVUS showed MSA of ostial LAD 8.31 mm2, and of distal LM 10.77 mm2 with TIMI 3 flow.ECMO decannulated on table
  




























Case Summary

- Even in patients who are declined for CABG, identifying the anatomy, accessing the viability, and revascularizing them with the help of mechanical circulatory device helps.- Viability assessment prevents unnecessary stenting.- Heart team approach plays the important role in CHIP.- Vessel bed preparation is important for success of PCI.- Drug eluting balloon angioplasty shows good result in diffusely diseased vessel.  

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