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Improved Angina Symptoms Following Coronary Sinus Flow Reducer Implantation in a Patient with Refractory Angina and Chronic Total Occlusion: A Case Report

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International Journal of Clinical Medicine 2019年第11期10卷 604-612页

作者： Crt Langel Mrak Miha Nejc Pavsic matjaz bunc Clinical Institute of Radiology University Medical Center Ljubljana Zaloska Ljubljana Slovenia Clinical Department of Cardiology University Medical Center Ljubljana Zaloska Ljubljana Slovenia

Background: Due to the aging population and increased survival of the patients with coronary artery disease, there is an increasing number of patients with debilitating angina refractory to optimal medical treatment who are not candidates for revascularization. In case of low ischemic load, the treatment of stable refractory angina is aimed at symptom reduction. There are several new treatment methods targeting myocardial ischemia available, including coronary sinus flow reducer (CFR) implantation. Case Report: We report a case of a patient suffering from CCS class IV angina despite optimal medical therapy, with further revascualrization options exhausted, who was successfully treated with coronary sinus flow reducer (CFR). Besides technical skill to reach ostium of coronary sinus, the most important technical tip is precise positioning of the CFR. The reduction of angina symptoms started after epithelisation of CFR frame, usually 6 - 7 weeks after implantation. At 6-month follow-up, the patient reported a marked reduction of angina symptoms, with CCS grade improving by three classes (from IV to I). At 10-month follow-up, the sustainment of CCS grade I angina symptoms was reported by the patient. Conclusions: We conclude that CFR can be safely and successfully implanted in patients suffering from refractory angina. Considerable improvements in CCS grade may be experienced in certain cases.

关键词： Chest Pain Refractory Angina Pectoris Myocardial Ischemia Coronary Sinus Flow Reducer Chronic Total Occlusion

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Successful Tavi in Patients with Previous Mitral Valve Replacement

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International Journal of Clinical Medicine 2012年第7期3卷 603-606页

作者： matjaz bunc Jana Ambrozic Spela Music Nikola Lakic P. Berden Rok Zbacnik Cerklje na Gorenjskem Trg Davorina Jenka Cerklje na Gorenjskem Clinical Institute of Radiology University Medical Centre Ljubljana Ljubljana Slovenia Department of Cardiology University Medical Centre Ljubljana Ljubljana Slovenia Department of Cardiovascular Surgery University Medical Centre Ljubljana Ljubljana Slovenia

Background: Transcatheter aortic valve implantation (TAVI) is a new method for patients with severe aortic stenosis at high surgical risk, such as previous cardiac surgery. The presence of mechanical mitral prosthesis might complicate TAVI because of possible interference between both prostheses. Some reports have already demonstrated the feasibility of TAVI in such patients. Case Reports: We report 2 patients with severe symptomatic aortic stenosis who had prior mitral valve replacement that successfully underwent TAVI with Edwards Sapien and CoreValve aortic prosthesis, re- spectively. Computed tomographic angiography (CTA) was useful for the assessment of the distance between both aor- tic and mitral prosthesis annuli. Transesophageal echocardiography was crucial for precise positioning of TAV. There were no special technical tips besides precise positioning of the valve prosthesis. In case of Core Valve the goal was the positioning at “zero point” and in case of Edwards Sapien valve a “half-on-half” position according to natural aortic valve. We observed no deformation or dysfunction of aortic and mitral prosthesis in any of the patients. Balloon valvu- loplasty prior to implantation helps to observe the mutual effect of the new aortic valve and pre-existent mitral prosthe- sis. Conclusions: We conclude that TAVI can be safely and successfully performed in patients with mechanical mitral prosthesis carefully considering the altered anatomical conditions. Skillfulness and TAVI experience of the operators should not be neglected.

关键词： TAVI Mitral Valve Replacement Aortic Prosthesis Mitral Prosthesis

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Improved Angina Symptoms Following Coronary Sinus Flow Reducer Implantation in a Patient with Refractory Angina and Chronic Total Occlusion: A Case Report

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International Journal of Clinical Medicine（临床医学国际期刊） 2019年第11期

作者： Crt Langel Mrak Miha Nejc Pavsic matjaz bunc

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Successful Tavi in Patients with Previous Mitral Valve Replacement

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International Journal of Clinical Medicine（临床医学国际期刊） 2012年第7期

作者： matjaz bunc Jana Ambrozic Spela Music Nikola Lakic P. Berden Rok Zbacnik

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