Acute Right Ventricular Failure After Successful Opening of Chronic Total Occlusion in Right Coronary Artery Caused by a Large Intramural Hematoma
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
- cardiac tamponade
- coronary artery disease
- coronary occlusion
- percutaneous coronary intervention
- ventricular dysfunction, right
A 76-year-old man with history of critical aortic stenosis was referred for surgical aortic valve replacement. Two months prior, preoperative diagnostic angiogram showed 2-vessel coronary artery disease, including 80% stenosis in midsection of left circumflex (LCX) artery, and serial lesions in the right coronary artery (RCA) with chronic total occlusion (CTO) of the distal segment (Movie I in the Data Supplement; Figure 1A) and significant left to right collateralization. At the time of surgical aortic valve replacement, coronary artery bypass was attempted; however, his saphenous veins were found to be unsuitable to use for bypass. His target vessels were deeply buried into myocardial fat as well. It was the heart team’s decision to bring him back for elective percutaneous coronary intervention (PCI). Unfortunately, 3 weeks after the aortic valve replacement surgery, the patient was admitted to medical service for urosepsis with mild elevation in troponin because of demand ischemia. His transthoracic echocardiogram showed normal left ventricle (LV) function with basal inferior and midseptal wall hypokinesis at this time. Given the elevated troponin and known need to perform complete revascularization, we proceeded to PCI of his 2-vessel disease, including the mid-LCX lesion and the CTO in the large RCA system after he recovered from infection.