- 65 years lady, DM, HTN
- Presented with high-risk NSTEMI and was referred for urgent coronary angiography
- borderline hemodynamics with bilateral basal crepitation
- She rapidly deteriorated and developed pulmonary edema and she was electively intubated.- She was immediately rushed to the Cath lab
Echo: severely impaired LVEF = 20% with moderate MR
She is known to have multi-vessel CAD for 3 years and she refused any intervention at that time. pre 1.wmv pre 2.wmv
> IABP was inserted
- Engagement of the LM was difficult due to ostial lesion, it was fished by a BMW wire and the guiding was positioned over it.
- Sion wire over corsair microcatheter was steered successfully into the 1st OM branch
- Difficulty to wire the LCX proper
- Predilatation for distal left main/ostial LCX and LAD, after which the LCX trunk was wire successfully.
> IVUS assessment was done for proper vessel sizing
- Further proper preparation by non-compliant balloons
- PCI to distal LCX and mid LAD followed by PCI to LM-LAD and LCX by cullotte technique
- followed by kissing balloon inflations and final POT (3 KBI and 3 POTS were performed, one after each stent)
- Final result was good with TIMI III flow
> Post PCIIVUS assessment
- MSA at LAD was7.9 mm2 at LCX, 9.2 mm2 at LAD, 12.5 mm2 at LMT
- Patient was transferred to ICU on high dose of Noradrenaline and adrenaline
- Extubated after2 days and IABP removed at day 4
> She suffered hectic ICU course:
- She developed CIN requiring dialysis for 4 sessions
- She developed 2attacks of hematemesis (stress ulcer ) and received PRBCS
- She developed hospital acquired pneumonia and received culture-based antibiotics.
> She was discharged home after 3 weeks.
- She came for follow up at outpatient clinics after 2 weeks and after 40 days
> Her LVEF recovered completely, she is doing fine, ambulatory and symptom-free.
A long story with fruitful end post 2.wmv post echo.wmv
CHIP is not uncommon in daily practice.
CHIP PCI is not a one-man show.
CHIP usually require a longer ICU stay, so be prepared and backed up with a powerful ICU team.Do not lose hope, severely Impaired LVEF recovers with optimum revascularization.