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Published on: November 4, 2015
Impact of right ventricular side branch occlusion during percutaneous coronary intervention of chronic total
Pepijn A van Diemen1, Wynand J Stuijfzand1, Stefan P Biesbroek1
1Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.
Insights
Right ventricular side branch occlusion during right coronary artery chronic total occlusion percutaneous coronary intervention did not significantly impact right ventricular ejection fraction, though a trend towards increased end-systolic volume was observed.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Imaging
Background:
- Percutaneous coronary interventions (PCI) for chronic total occlusions (CTOs) have advanced, increasing feasibility.
- Complex PCI techniques, including dissection and reentry, raise the risk of coronary side branch occlusion.
- Right ventricular side branch (RVB) occlusion is a potential complication during right coronary artery (RCA) CTO PCI.
Purpose of the Study:
- To evaluate the impact of right ventricular side branch (RVB) occlusion during PCI of RCA CTOs on right ventricular (RV) function.
- To assess changes in RV volumes and ejection fraction following successful RCA CTO PCI.
- To investigate the effect of RVB recruitment on RV function post-PCI.
Main Methods:
- Fifty-four patients undergoing successful RCA CTO PCI were assessed using cardiac magnetic resonance imaging (CMR) before and three months after the procedure.
- Quantification of right ventricular end-diastolic volume (RVEDV), end-systolic volume (RVESV), and ejection fraction (RVEF) using CMR.
- Assessment of RVB occlusion and recruitment via procedural angiograms.
Main Results:
- RVB occlusion occurred in 22% of patients; RVB recruitment in 13%.
- No significant difference in RVEF was found between baseline and follow-up (53.8% vs. 53.9%, p=0.95).
- RVB occlusion did not significantly alter RVEDV or RVEF, but showed a trend towards increased RVESV (p=0.05). RVB recruitment did not improve RVEF.
Conclusions:
- RVB occlusion during RCA CTO PCI is not associated with a significant decrease in RVEF at follow-up.
- A potential trend towards increased RVESV suggests a possible, albeit limited, impact on RV remodeling.
- RVB recruitment did not demonstrate a significant functional benefit for the right ventricle.
Objective:
To determine the impact of right ventricular side branch (RVB) occlusion, during percutaneous coronary interventions (PCIs) of chronic total occlusions (CTOs) of the right coronary artery (RCA), on right ventricular (RV) function.
Background:
Developments in PCI techniques have expanded PCI CTO feasibility. However, the utilization of dissection and reentry techniques and extensive stent implantation increases the risk of coronary side branch occlusion.
Methods:
Fifty-four patients (80% male, 63±10years) evaluated with cardiac magnetic resonance imaging (CMR) prior and three months after successful PCI CTO RCA (median: 99days, IQR: 92-105days) were included. Right ventricular end-diastolic volume (RVEDV), end-systolic volume (RVESV), and ejection fraction (RVEF) were quantified on CMR images. Occurrence of RVB occlusion and/or RVB recruitment was assessed using procedural angiograms.
Results:
RVB occlusion was observed in 12 patients (22%), while RVB recruitment occurred in seven patients (13%). Overall, RVEF was comparable between baseline and follow-up (53.8±5.8 vs. 53.9±5.8%, p=0.95). RVB occlusion was not associated with a significant change in RVEDV or RVEF (156.9±36.3 vs. 162.1±35.5mL, p=0.30 and 54.2±3.9 vs. 52.7±4.4%, p=0.19, respectively); however a trend was observed for an increase of RVESV (72.5±20.0 vs. 77.4±20.7mL, p=0.05) at follow-up. RVB recruitment did not result in a significant improvement of RVEF (55.4±4.6 vs. 56.1±5.3%, p=0.75).
Conclusion:
RVB occlusion was not associated with a significant decreased RVEF at follow-up, although the results suggested a limited increase of RVESV.
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