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Intramural coronary hematoma, a complex three-dimensional entity: Multimodality assessment

Iván J Núñez-Gil1, Mauro Echavarría-Pinto1, Gisela Feltes1

  • 1Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain.

Revista Portuguesa De Cardiologia : Orgao Oficial Da Sociedade Portuguesa De Cardiologia = Portuguese Journal of Cardiology : an Official Journal of the Portuguese Society of Cardiology
|March 27, 2017
PubMed

Insights

A patient with chest pain experienced persistent left coronary artery flow issues despite initial treatment. Advanced imaging like optical coherence tomography and intravascular ultrasound were crucial for diagnosis and optimizing care.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Interventional Cardiology

Background:

  • Acute chest pain presentation in a 62-year-old woman.
  • Electrocardiogram (ECG) changes and reduced left ventricular ejection fraction (30%) on echocardiogram indicated significant cardiac compromise.

Observation:

  • Emergent cardiac catheterization revealed severe flow disturbance in the left coronary artery.
  • Initial interventions including an intra-aortic balloon pump and drug-eluting stent implantation did not fully resolve the flow disturbance.

Findings:

  • Optical coherence tomography (OCT) and intravascular ultrasound (IVUS) provided critical insights into the underlying mechanism of persistent coronary artery flow disturbance.
  • These advanced intravascular imaging techniques were instrumental in guiding further treatment optimization.

Implications:

  • OCT and IVUS are valuable tools for complex coronary interventions when initial treatments fail.
  • Optimized treatment strategies based on detailed intravascular imaging can improve outcomes in critical cardiac patients.

Keywords:
Acute coronary syndromeCoronary dissectionDisseção coronáriaIntravascular ultrasoundOptical coherence tomographySíndrome coronária agudaThree-dimensional optical coherence tomographyTomografia de coerência óticaTomografia de coerência ótica 3-DUltrassonografia intravascular

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