Precision management of severe coronary artery calcification with concomitant left ventricular outflow tract obstruction: a case report

Figures

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  Figure 1. Electrocardiography and transthoracic echocardiography of the patient. (A) Electrocardiography. (B) Transthoracic echocardiography. Red arrow indicates left ventricular outflow tract (LVOT) obstruction.

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  Figure 2. Coronary angiography results before and after stent implantation in the patient. (A) Coronary angiography before stent implantation showing multivessel disease with severe left circumflex artery (LCX) stenosis and heavy calcification. Quantitative flow ratio (QFR) measured 0.44, indicating hemodynamically significant stenosis requiring intervention. (B) Coronary angiography after stent implantation showing successful lesion modification. Two stents (2.5 × 28 mm and 3.5 × 24 mm) were implanted with post-dilation, achieving a QFR of 0.96. MLD, Minimum Lumen Diameter; MDSR, Minimal Diameter Stenosis Rate; MASR, Minimal Area Stenosis Rate; BFV, Blood Flow Velocity; Rest Pd/v, Resting Distal-to-Aortic Pressure Ratio (Pd/Pa); Sim-hyp Pd/v, Simulated Hyperemic Distal-to-Aortic Pressure Ratio (Pd/Pa); QFR, Quantitative Flow Ratio.

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  Figure 3. The coronary angiography and intravascular imaging with intravascular ultrasound (IVUS) images of left anterior descending artery (LAD). (A) The Coronary angiography and QFR of LAD; (B) Intravascular imaging with intravascular ultrasound (IVUS) at FRAME 395, (C) FRAME 429, (D) and FRAME 612. MLD, Minimum Lumen Diameter; MDSR, Minimal Diameter Stenosis Rate; MASR, Minimal Area Stenosis Rate; BFV, Blood Flow Velocity; Rest Pd/v, Resting Distal-to-Aortic Pressure Ratio (Pd/Pa); Sim-hyp Pd/v, Simulated Hyperemic Distal-to-Aortic Pressure Ratio (Pd/Pa); QFR, Quantitative Flow Ratio.

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  Figure 4. Cardiac magnetic resonance imaging and transthoracic echocardiography after PCI intervention in the RCA and LCX. (A) Post-intervention cardiac magnetic resonance imaging. Red and yellow arrows indicated the left ventricular hypertrophy and left ventricular outflow tract obstruction, respectively. (B) Transthoracic echocardiography after PCI in the RCA and LCX. (C) Resting transthoracic echocardiography after 4 months of mavacamten treatment. (D) Transthoracic echocardiography during the Valsalva maneuver.