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

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 Waseda, Akihiro Suzuki, Hirohiko Ando, Hirofumi Ohashi, Hiroaki Takashima, Tetsuya Amano

■ 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

■ Relevant Tests prior to Catheterization WBC 4500 / μl BUN 12.7 mg/dl × 10 4 / μl RBC 415 Cre 0.65 mg/dl ml/min/1.73m 2 Hb 13.9 g/dl eGFR 73 Ht 48.8 % UA 4.7 mg/dl × 10 4 / μl Plt 32.7 Na 145 mEq/L K 4.2 mEq/L No abnormality, CTR 45% TP 7.6 g/dl Cl 104 mEq/L ALB 4.3 g/dl CRP 0.10 mg/dl T-Bil 0.55 mg/dl BNP 19.9 pg/ml AST 21 U/L ALT 21 U/L HbA1c 5.5 % ALP 364 U/L TG 309 mg/dl LDH 175 U/L HDL-C 64 mg/dl CPK 59 U/L LDL-C 162 mg/dl Sinus rhythm, HR 60 bpm Aichi Medical University

■ Relevant Tests and Catheterization • Coronary CT angiography • Stress Scintigraphy • Coronary Angiography Aichi Medical University

Coronar ary y CT A Angiograp aphy Volume Renderling imag age

MPR i imag age (multi i plan anar ar reconstruction) Ao PA Aichi Medical University

■ Relevant Tests and Catheterization • Coronary CT angiography • Stress Scintigraphy • Coronary Angiography Aichi Medical University

■ Relevant Tests and Catheterization • Coronary CT angiography • Stress Scintigraphy • Coronary Angiography Aichi Medical University

Coronar ary y Angiograp aphy Ao PA CRA 30° LAO 30° Aichi Medical University

Coronar ary y Angiograp aphy Ao PA Aichi Medical University

control (without breath holding) IVUS (breat ath holding te test) t) PA Ao Ao Ao Φ 2.3×2.1mm PA PA Ao

FFR (breath holding test)

■ 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

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

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.