CASE20210627_001
Don’t Let the Perfect be the Enemy of the Good.
By
0
Presenter
Shariful Islam
Authors
1
Affiliation
, Bangladesh1
Complications - Complications
Don’t Let the Perfect be the Enemy of the Good.
1
, Bangladesh1
Clinical Information
Patient initials or Identifier Number
X
Relevant Clinical History and Physical Exam
Mr. X, 50 years male, smoker, hypertensive, non-diabetic, admitted toNICVD with the complaints of worsening central chest pain which corresponds to CCS class-III for 3 days on the background of exertional chest pain for last 4 months and diagnosed as a case of AMI (Inf).
On examination: Pulse:76/min,regular; BP: 110/80 mmHg; Lung bases: clear
Media1.wmv Media2.wmv Media3.wmvRelevant Test Results Prior to Catheterization
Non-Invasive StudyECG: AMI(Inf); Echocardiography: Inferior wall hypokinesia, LV EF 45%; Troponin I: Raised, Biochemistry: Normal
Invasive Test ReportLM,LAD,Lcx—NormalRCA----90-95% Stenosis in Mid Part
Invasive Test ReportLM,LAD,Lcx—NormalRCA----90-95% Stenosis in Mid Part
Relevant Catheterization Findings
Interventional Management
Procedural Step
First 6F JR Catheter was used. Wiring Done. Here we use Floppy wire. Predilatation (2X15mm @12 atm) & Stenting(3X38mm) of apparently type A RCA lesion (90-95%). Post dilatation 3.5X10mm @16atm. But we are not satisfied with this result.So Again Post Dilation was done. Here we use higher size balloon about 4.0 mm.
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Media4.wmv Media5.wmv Media6.wmv Media7.wmv Media8.wmvCase Summary
CAP remains a rare complication and high index of suspicion and localization of perforation is needed.Urgent and serial echocardiographic monitoring.Stop the bleeding first with optimization of ACT.Prolonged balloon dilatation always.May need cover stent.Quick pericardiocentesis.Worse outcomes if emergency surgery is warranted.