[Successful Surgical Management for Ischemic Heart Failure with Fractional Flow Reserve Derived from Computed...

Area of Science:

• Cardiology
• Medical Imaging
• Cardiac Surgery

Background:

• Coronary artery disease (CAD) and mitral valve regurgitation (MVR) often coexist, requiring comprehensive assessment for optimal treatment.
• Accurate identification of ischemic coronary lesions is crucial for planning effective coronary artery bypass grafting (CABG).

Observation:

• A 71-year-old female presented with symptoms necessitating mitral valve repair and CABG.
• Conventional coronary angiography revealed stenosis in the right coronary artery (RCA) and diagonal branches.
• Transthoracic echocardiography (TTE) indicated diffuse hypokinesis and mild-to-moderate MVR.

Findings:

• Fractional flow reserve derived from computed tomography (FFRct) identified previously undetected significant lesions in the left anterior descending (LAD) and high lateral (HL) branches.
• The patient underwent successful CABG of the RCA, LAD, second diagonal, and HL branches, along with mitral valve repair.
• Post-operative TTE at one year demonstrated trivial MVR and significant improvement in left ventricular wall motion and ejection fraction.

Implications:

• FFRct is a valuable non-invasive tool for detecting ischemia-causing coronary lesions, complementing conventional angiography.
• Integrated assessment using FFRct and echocardiography can optimize surgical planning for complex cardiac conditions.
• Improved cardiac function and reduced mitral regurgitation were observed one year after combined surgical intervention.