Key result
Continuous cardiac output monitoring detects an occult ~38% flow drop during left main rotational atherectomy.
Case Report (n=1)
No
Continuous cardiac output monitoring during high-risk left main PCI can detect severe hemodynamic compromise masked by stable arterial pressure in patients with limited contractile reserve, enabling timely intervention before overt cardiogenic shock.
Stable pressure may mask cardiac output decline in high-risk PCI; leaves open whether continuous monitoring improves outcomes.
Background Severely calcified, unprotected left main (LM) bifurcation intervention carries high hemodynamic risk. Case Summary An 82-year-old woman with prior aortic valve replacement, occluded bypass grafts, and left ventricular ejection fraction (LVEF) 41% underwent percutaneous coronary intervention for a severely calcified distal LM bifurcation (SYNTAX score I 45). Under intra-aortic balloon pump support and continuous cardiac output (CO) monitoring, dual-guide (“ping-pong”) rotational atherectomy was performed. CO fell 38% (3.9 to 2.4 L/min) while arterial pressure remained stable, prompting immediate interruption of atherectomy and inotropic and vasopressor support. A three-stent reconstruction was completed; LVEF recovered to 55% without new wall-motion abnormality. Discussion Continuous CO monitoring identified hemodynamic deterioration not reflected in arterial pressure, allowing atherectomy to be interrupted and support escalated before overt hypotension or cardiogenic shock developed. Take-Home Message In patients with limited contractile reserve, stable arterial pressure may mask declining CO during high-risk coronary intervention.
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Pardi et al. (2026) conducted a case report in Severely calcified, unprotected distal left main coronary bifurcation stenosis (n=1). Dual-guide rotational atherectomy and three-stent PCI under IABP and continuous cardiac output monitoring was evaluated on Hemodynamic stability and left ventricular ejection fraction recovery. Continuous cardiac output monitoring during left main rotational atherectomy detected a 38% CO drop (3.9 to 2.4 L/min) despite stable arterial pressure, allowing successful intervention (LVEF 55%).
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