Author + information
Patient initials or identifier number
Relevant clinical history and physical exam
She was 47 years -old. Her younger brother died suddenly with aortic aneurysm rupture, She was diagnosed with the Marfan syndrome, and aortic valve ring dilated gradually.She had Modified Yacoub operation. It was good, but she had severe chest pain with cold sweating 6 days after the operation. The blood pressure fell to 70-80 mmHg and it became 30 heart rates and became the cardiac arrest. 20-30 heart rates continued and were seen ST elevation by limbs instruction with an electrocardiogram.
Relevant test results prior to catheterization
Electrocardiogram showed heart rate 30 bpm and ST elevation in II, III, a VF lead.
In the coronary computered tomography before her symptom appeared on the same day, a remarkable stenosis lesion twisted pressed outside in right coronary artery ostium was recognized.
Relevant catheterization findings
After a pacemaker insertion, we performed a coronary angiogram. It showed right coronary ostium was very occluded and was not seen clearly from every direction.
We performed pericutaneous coronary intervention immediately and could cross wire somehow, so the bloodstream was improved TIMIIand after dilated the lesion by 2.0 mm balloon, her heart rate rised over 80 bpm. Intravascular ultrasound (IVUS) findings were that vessel was 5-6 mm diameter and pushed like twisted by the outside. We implanted a smaller 3.0 × 15 mm stent carefully and checked IVUS again. It showed stretched and recovered coronary artery in an original figure. Then dilated the lesion 5.0 mm balloon in ease and implanted another stent at RCA ostium.
We experienced an STEMI case that coronary ostium was not clear in CAG. however, we could pass a wire somehow, and got bloodstream of TIMIIII and stability of vital got by the expansion with a smaller balloon. The cause of occlusion was not plaque than preoperative coronary CT and multiple IVUS views. It was thought that it was caused by the torsion of coronary artery or pressure from the outside. After stent implantation, we could expand with a bigger balloon in the ease with IVUS views, and good expansion, bloodstream were got IVUS was extremely effective in the case that coronary occlusion mechanism was unknown, and we should use it without hesitating.