Improvement of symptoms and coronary perfusion gradient with mechanical left ventricular unloading in flow‐limiting complex spontaneous coronary artery dissection, without revascularization

Figures

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  FIGURE 1. Panel A shows baseline EKG with an ST‐elevation in anterior leads; an extensive flow limiting SCAD involving LAD and diagonal branch was evident at angiography (panel B). LVEDP was increased at baseline (35 mmHg), while it significantly decreased to 17 mmHg during Impella CP unloading (panel C and D). Panel E highlights the beneficial effect of unloading system on myocardial perfusion gradient, through an increase in systolic, diastolic, and mean aortic pressure and a decrease in LVEDP. The unloading therapy allowed a regression of symptoms and ST abnormalities (panel F) and an improved run‐off of the LAD as well as a relief of the SCAD in the diagonal branch (panel G). DBP, diastolic blood pressure; LAD, left anterior descending artery; LVDEP, left ventricle end‐diastolic pressure; MAP, mean arterial pressure; SBP, systolic blood pressure; SCAD, spontaneous coronary artery dissection

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  FIGURE 2. Three dimensional multiplanar reconstruction and volume rendering of 1‐month coronary CT scan, which shows patency of native LAD (panel A) and diagonal branch (panel B) with good opacification of their distal segments. LAD, left anterior descending artery;