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Four-Dimensional Computed Tomography-Guided Valve Sizing for Transcatheter Pulmonary Valve Replacement
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Three-dimensional relationship between the conus branch and the precordial leads confirmed by 64-multidetector-row

Shumpei Mori1, Makoto Takamiya, Kenji Suzuki

  • 1Division of Cardiology, Sendai Kousei Hospital, Miyagi, Japan. shumpei_8@hotmail.com

Journal of Electrocardiology
|November 4, 2008
PubMed

Insights

Percutaneous coronary intervention can inadvertently occlude the conus branch (CB), leading to ST elevation myocardial infarction. Recanalization of the CB is crucial for successful treatment.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Diagnostic Imaging

Background:

  • Effort angina pectoris management often involves percutaneous coronary intervention (PCI).
  • Bare-metal stents are commonly used for coronary artery lesions.
  • The conus branch (CB) is a critical coronary artery supply.

Observation:

  • A 65-year-old man with angina underwent PCI of the proximal right coronary artery.
  • The conus branch (CB) became jailed and occluded during stent placement.
  • Electrocardiogram (ECG) showed significant ST elevation in anterior leads (V1-V3).

Findings:

  • Supplementary ECG leads positioned higher revealed more prominent ST elevation in V1-V3.
  • 64-multidetector-row computed tomographic coronary angiography confirmed CB recanalization.
  • The CB was located centrally between V1 and V2 electrodes.

Implications:

  • Jailing and occlusion of the CB during PCI can cause myocardial infarction.
  • ECG interpretation with supplementary leads can aid in diagnosing CB occlusion.
  • CT coronary angiography is valuable for assessing CB patency post-PCI.

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