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and Fractional Flow Reserve Aichi Medical University, Japan Atomu - - PowerPoint PPT Presentation

Oct 25, 2022 379 likes •568 views

TCTAP 2019 Effect of Breath Holding on Coronary Stenosis Sandwiched Between Aorta and Pulmonary Artery Assessed with Intravascular Ultrasound and Fractional Flow Reserve Aichi Medical University, Japan Atomu Tajima, Yusuke Nakano, Katsuhisa

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SLIDE 1

Effect of Breath Holding on Coronary Stenosis Sandwiched Between Aorta and Pulmonary Artery Assessed with Intravascular Ultrasound and Fractional Flow Reserve

Aichi Medical University, Japan

Atomu Tajima, Yusuke Nakano, Katsuhisa Waseda, Akihiro Suzuki, Hirohiko Ando, Hirofumi Ohashi, Hiroaki Takashima, Tetsuya Amano

TCTAP 2019

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SLIDE 2

■Relevant Present and Past Clinical History

  • 53-year-old female
  • Chest oppression lasting for 10 minutes on effort
  • No medical history, No smoking history

■Physical Exam

  • Height162cm; Weight 74kg
  • Blood pressure 133/63 mmHg; Pulse 54 bpm
  • No heart murmur;

Respiratory sound clear; No edema.

Aichi Medical University

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SLIDE 3

■Relevant Tests prior to Catheterization

Aichi Medical University

BUN 12.7 mg/dl Cre 0.65 mg/dl eGFR 73 ml/min/1.73m2 UA 4.7 mg/dl Na 145 mEq/L K 4.2 mEq/L Cl 104 mEq/L CRP 0.10 mg/dl BNP 19.9 pg/ml HbA1c 5.5 % TG 309 mg/dl HDL-C 64 mg/dl LDL-C 162 mg/dl WBC 4500 /μl RBC 415 ×104/μl Hb 13.9 g/dl Ht 48.8 % Plt 32.7 ×104/μl TP 7.6 g/dl ALB 4.3 g/dl T-Bil 0.55 mg/dl AST 21 U/L ALT 21 U/L ALP 364 U/L LDH 175 U/L CPK 59 U/L No abnormality, CTR 45% Sinus rhythm, HR 60 bpm

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SLIDE 4

■Relevant Tests and Catheterization

  • Coronary CT angiography
  • Stress Scintigraphy
  • Coronary Angiography

Aichi Medical University

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SLIDE 5

Coronar ary y CT A Angiograp aphy Volume Renderling imag age

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SLIDE 6

MPR i imag age

(multi i plan anar ar reconstruction)

Ao PA

Aichi Medical University

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SLIDE 7

■Relevant Tests and Catheterization

  • Coronary CT angiography
  • Stress Scintigraphy
  • Coronary Angiography

Aichi Medical University

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SLIDE 8
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SLIDE 9

■Relevant Tests and Catheterization

  • Coronary CT angiography
  • Stress Scintigraphy
  • Coronary Angiography

Aichi Medical University

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SLIDE 10

Coronar ary y Angiograp aphy

Aichi Medical University

CRA 30° LAO 30°

Ao PA

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SLIDE 11

Coronar ary y Angiograp aphy

Aichi Medical University Ao PA

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SLIDE 12

IVUS (breat ath holding te test) t)

Ao PA PA Ao

Φ2.3×2.1mm control (without breath holding)

Ao PA Ao

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SLIDE 13
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SLIDE 14

FFR (breath holding test)

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SLIDE 15

■Summary

  • Coronary CT angiography showed coronary stenosis

sandwiched between aorta and pulmonary artery in the single coronary disease.

  • Breath holding induced flow limitation of the equivalent of

RCA sandwiched with large vessels.

  • However, no evidence of significant ischemia was shown to

the lesion. Therefore, conservative medical treatment was provided without coronary intervention.

Aichi Medical University

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SLIDE 16

Discussion Points

  • What is the ischemic mechanism of

the present single coronary artery case?

  • How should we manage this patient?
  • regarding life guidance and treatment
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SLIDE 17

Conclusion/Take-home Message

  • Coronary stenosis was worsened under breath

holding in the single coronary disease sandwiched with aorta and pulmonary artery.

  • These stenotic changes were observed

by IVUS and FFR in real time.