(IV-1C.3a) Patient after operation of complex congenital heart disease with left ventricle ischaemia Agnieszka Żygadło MD, Lidia Tomkiewicz-Pająk MD, PhD, Leszek Drabik MD, PhD, Monika Smaś-Suska MD, Natalia Dłużniewska MD, Prof. Maria Olszowska MD, PhD, Prof. Piotr Podolec MD, PhD

 

BRIEF COMMENTS

EXPERT: Prof. Janusz Skalski, MD PhD, pediatric cardiac surgeon
Affiliation: Department of Pediatric Cardiac Surgery, Jagiellonian University Medical College, Krakow
COMMENT
Computed tomography picture suggests that the homograft compresses the left coronary artery causing exercise ischemia. The homograft, in my opinion, should be replaced surgically. Coronary angiography should be performed, in order to investigate coronary arteries status. Reconsultation should be done before deciding for any coronary intervention coronary angiography.

EXPERT: Tomasz Mroczek, MD PhD, pediatric cardiac surgeon
Affiliation: Department of Pediatric Cardiac Surgery, Jagiellonian University Medical College, Krakow.
COMMENT
Surgical homograft replacement might not be feasible. There is a risk of left coronary artery damage. Perhaps coronary bypass-graft to LCA is worth considering. Place of the coronary artery compression doesn’t seem suitable for stent implantation.

EXPERT: Assoc. Prof. Bogusław Kapelak MD, PhD, cardiac surgeon
Affiliation: Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow
COMMENT
More detailed radiological description of the place of the coronary artery compression would be desirable. Stent implantation doesn’t seem possible – homograft is too calcified. Operation is charged with high risk due to possible tissue adhesions located around the homograft. Perhaps LIMA-LCA bypass-graft will be the option for this patient. Decision should be made after angiography.

EXPERT: Tomasz Pawelec MD, PhD, cardiologist
Affiliation: Department of Hemodynamics, John Paul II Hospital, Krakow
COMMENT
Coronary angiography might be useful in order to decide whether percutaneous intervention is feasible. Perhaps, balloon extension and eventual stent implantation is possible.

EXPERT: Prof. Piotr Podolec MD, PhD, cardiologist
Affiliation: Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow
COMMENT
The patient has a very good exercise tolerance and is asymptomatic with reference to myocardial ischemia. As there are no clear indications for invasive procedures or surgery at this time coronary angiography is in my opinion controversial. More detailed non-invasive diagnostic procedures should be considered. Close observation every 6 month should be carried on.

EXPERT: Grzegorz Kopeć MD, PhD, cardiologist
Affiliation: Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow
COMMENT
In my opinion angiography and stent implantation in case of clinically evident stenosis is the option to consider. In pulmonary hypertension patients with coexisting coronary artery compression by the dilated pulmonary trunk percutaneous stent implantation has been done with successful outcome.

CONCLUSIONS

1) Coronary angiography is controversial
2) Patient without symptoms, with good exercise tolerance – decision about angiography and intervention after discussion with the patient.
3) Invasive diagnostic procedures in case of deterioration


“Development of the European Network in Orphan Cardiovascular Diseases”
„Rozszerzenie Europejskiej Sieci Współpracy ds. Sierocych Chorób Kardiologicznych”

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