PROCEDURES PERFORMED:
1. Right heart catheterization.
2. Selective coronary arteriogram.
3. Left heart catheterization.
4. Left ventriculogram.
5. Aortogram.
6. StarClose.
INDICATIONS FOR PROCEDURE: The patient is a (XX)-year-old woman with a history of unexplained abrupt cardiomyopathy. She was referred for further evaluation, including right heart catheterization and above procedures.
DETAILS OF PROCEDURE: Informed consent was obtained for right heart catheterization and above procedures. A 7 French right femoral venous sheath was placed and a 6 French right femoral arterial sheath was placed.
A Swan-Ganz catheter was placed in the standard fashion, and serial hemodynamic measurements were made including pressures, O2 saturations and cardiac outputs.
Diagnostic angiography was performed using 6 French JL4 and JR4 catheters. A left ventriculogram was performed using a 6 French angled pigtail catheter. The catheter was then pulled back, and an aortogram was performed.
Subsequently, all catheters were removed. The sheath was removed using a StarClose device, and the venous sheath was removed with hemostasis. The patient tolerated the procedure well.
HEMODYNAMICS:
Pressures:
RA mean of 4.
RV 33/6
PA 35/13, PA mean 24
Pulmonary capillary wedge 14
Cardiac output 3.7 L/min by thermodilution
Cardiac index 2.4
O2 Saturations:
RA 76 on 2 L
PA 70 on 2L
FA 97 on 2 L
Left ventricular end diastolic pressure 18 mmHg.
No gradient on pullback across the aortic valve.
ANGIOGRAPHY:
1. The left main coronary artery is angiographically normal.
2. There is an eccentric 20% stenosis of the LAD just after takeoff of the first diagonal branch and after takeoff of the first septal perforator branch. The vessel is otherwise angiographically normal.
3. The circumflex artery is angiographically normal.
4. The right coronary artery is dominant and angiographically normal.
5. Left ventriculogram shows severe diffuse hypokinesis. Estimated left ventricular ejection fraction is 15-20%. There is noted 1+ mitral insufficiency. Left ventricular end diastolic pressure is 18. No gradient on pullback across the aortic valve.
6. An aortogram shows 2+ aortic insufficiency. The aorta is otherwise normal in size with mild calcification. There is no evidence for dissection.
CONCLUSIONS:
1. Essentially normal epicardial coronary arteries.
2. Severe left ventricular systolic dysfunction.
3. Mild mitral and aortic insufficiency.
4. Mildly elevated right heart pressures.
PLAN: Aggressive medical management for unexplained cardiomyopathy. Based on the patient’s history, this is possibly a stress cardiomyopathy versus viral cardiomyopathy. The patient will follow up closely with her primary physician as well as with us.
