A Case of Rota-Shock-Pella

Ka Chun Alan Chan, Ngai Hong Vincent Luk, Kang Yin Michael Lee, Kam Tim Chan
2019 JACC Case Reports  
Severe calcified coronary lesions are frequently encountered in today's percutaneous coronary intervention practice and remain a challenging entity in complex and high-risk patients. The present case illustrates the contemporary approach to management of this coronary problem from hemodynamic support, optical coherence tomography assessment, and plaque modification technique. (Level of Difficulty: Advanced.) (J Am Coll Cardiol Case Rep 2019;1:765-70) This is an open access article under the CC
more » ... ticle under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). PRESENTATION A 74-year-old gentleman presented to the emergency department for acute decompensated heart failure. He had 2-week history of progressive exertional dyspnea and lower limb edema before admission. He did not have angina, palpitation, or syncope. MEDICAL HISTORY The patient had history of hypertension, hyperlipidemia, and diabetes mellitus. He was a nonsmoker. INVESTIGATION Laboratory tests showed normal renal function and troponin level. Electrocardiogram showed sinus tachycardia whereas chest radiography revealed cardiomegaly and congested lung field. Echocardiography showed globally impaired left ventricular ejection fraction of 25% to 30% and with multiple regional wall motion abnormalities. There was only mild mitral regurgitation. Coronary angiography (Figure 1, Videos 1 and 2) performed as part of the ischemic workup showed a nondominant LCX and diffuse severe calcification along the left main, LAD, and RCA. There was severe stenosis in the distal left main, proximal LAD and proximal RCA. Mid LAD and mid RCA were totally occluded. Nuclear stress imaging showed multiple regions of ischemia without infarct. MANAGEMENT The patient was stabilized with anti-heart failure medication. The case was discussed among the heart team, but bypass surgery posed too high risk and was turned down as the distal targets were poor. High-risk percutaneous coronary intervention (PCI)
doi:10.1016/j.jaccas.2019.10.028 fatcat:oenbp4bjibewheaog2w24xaeka