TCTAP & AP VALVES 2020 Virtual

CASE20200923_002

High-Risk Intervention (diabetes, heart failure, renal failure, shock, etc) - High-Risk Intervention
Primary Angioplasty of Left Main with Cardiogenic Shock & Pulmonary Oedema with IABP Support
Hariom Tyagi¹
Lokpriya Hospital, India¹,

[Clinical Information] - Patient initials or identifier number: L K -Relevant clinical history and physical exam: This45 year old gentleman- a known case of old AWMI (post PTCA to LAD in 2011)presented to us with severe retrosternal chest pain &dyspnoea a/w sweating for last 3 hours. The patient wasin Killip Class IV with cardiogenic shockand recurrent VT. vECG: LBBB, Diffuse ST depressionin all leads except aVR & V1 & ST elevationin I,aVL & aVR v2 DEcho suggestive of severe LV Systolic Dysfunction( LVEF-20%),SevereMR, Moderate TR ,Moderate PAH -Relevant test results prior to catheterization: ^{The patient was taken for Urgent CAG withintent to primary angioplasty.} ^{Coronary angiography suggested critical LM stenosis with significant ISR of LADstent in proximal part.} - Relevant catheterization findings: ^{Patient was put on Intra-aortic balloonpump.} ^{JL 3.5- 7F guiding catheter was engaged inleft cusp near LM ostium} ^{After crossing the lesion & serial predilatation with semicompliant balloons, 4.0x 23 Xience Prime DES was implanted from LM to LAD covering the ISRsegment.} ^{Post dilatation with proximal optimization was done using4.5x 8 mm NC sprinter balloon}
[Interventional Management] - Procedural step: After explaining the high risk & takingconsent of death on table IABP support (34cc linear balloon) was put through leftfemoral artery. *Left CoronaryArtery:-* JL 3.5,7F guide catheterwas engaged in left cusp near Left main ostium A 0.014” RUNTHROUGH WIRE was parkedin distal LAD & another 0.014 BMWwire was parked in LCX. Pre dilatation done with SC sprinter balloon 2.5 x 12mm @ 10-12 atm & another balloon NC sprinter balloon 3.0 x 9 mm @12-14 atm.Drug eluting Stent Xience Prime 4.0 x 23mm was deployed from Left Main to LAD @ 12 atmosphere. Post dilatation donewith NC sprinter balloon 4.5 x 8 mm @ 14 atm. GP IIb IIIa inhibitor andtemporally pacemaker were used during the procedure. Excellent result with TIMIIII flow. Successful PTCA with stenting to Left Main. - Case Summary: Significant (defined as a greater than 50 percentangiographic narrowing) left main coronaryartery disease (LMCAD) is found in 4 to 6 percent ofall patients who undergo coronary arteriography. It is associated with multivessel coronary artery disease about 70 percent of the time

E-Science Station