Coronary physiology to guide treatment of coronary artery disease in a patient with severe aortic valve stenosis: friend or foe? A case report

Figures

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  Figure 1. Angiographic image of the coronary stenosis. (A) The angiographic image of the right coronary artery stenosis through an left anterior oblique view. The stenosis is marked by the white arrow. (B) The angiographic image of the right coronary artery after the placement of two drug eluting stents.

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  Figure 2. Changes in coronary haemodynamics after transcatheter aortic valve implantation. The top panel shows the angiographic view of the degenerated aortic valve and the coronary haemodynamic measurements during the valve work-up. The lower panel shows the angiographic view of the transcatheter aortic valve implantation prosthesis in the biological valve and the haemodynamic measurements of the same right coronary artery lesion 6 months after the valve procedure. AV, aortic valve; (PB-) CFR (norm), (pressure-bound) coronary flow reserve (normalized); IMR (norm), index of microvascular resistance (normalized); Pa, proximal coronary pressure; Pd, distal coronary pressure; RRR, resistive reserve ratio; TAVI, transcatheter aortic valve implantation.

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  Figure 3. Non-invasive ischaemia testing. The figure shows the results of the myocardial perfusion single photon-emission computed tomography. Regadenoson was used to induce a stress response. A reversible perfusion defect of 15% can be seen in the inferior and inferolateral wall corresponding with the right coronary artery perfusion territory. On the left the perfusion defect is marked with white arrows. On the right the perfusion defect area is traced with white lines. The perfusion defect has an summed stress score of 14 and summed defect score of 6, a delta (Δ) extent of 12% and a delta (Δ) TPD of 9%. SDS, summed defect score; SPECT, single photon-emission computed tomography; SRS, summed rest score; SSS, summed stress score; TPD, total perfusion deficit score.