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After informed consent, explaining risks and benefits of the procedure to the patient, the patient was brought to the cardiac catheterization lab. The right groin was prepped and draped in the usual sterile fashion. Twenty mL of 2% lidocaine was infiltrated in the right groin for local anesthesia. A 6-French sheath was placed in the right common femoral artery using modified Seldinger technique. A 6-French Judkins left 4 catheter was used to engage the left main coronary artery. A 6-French 3DRC catheter used to obtain right coronary angiogram. A 6-French pigtail catheter was used to obtain a ventriculogram and to obtain ventricle and aortic pressures, respectively. A right common femoral angiogram was used to document the arteriotomy site to be above the common femoral artery bifurcation. A 6-French Angioseal was used as a vascular closure device. There were no complications.
RESULTS
HEMODYNAMICS
1. Ventricular pullback aortic pressure 130 systolic, 80 diastolic, LV pressures 130 systolic, 16 end diastolic. Left ventricular end-diastolic pressure of 16 mmHg.
There is no systolic gradient noted across the aortic valve on ventricular pullback.
VENTRICULOGRAM
A ventriculogram was performed in standard 30-degree RAO position, which demonstrated a low normal left ventricular ejection fraction of 45% to 50%. There was no mitral regurgitation noted.
SELECTIVE CORONARY ANGIOGRAM
1. Left main coronary artery demonstrated luminal irregularities.
2. Left anterior descending was moderately calcified with a moderate eccentric 60% mid LAD stenosis. The distal LAD demonstrated a 40% stenosis, which appeared to be an intramyocardial portion of the distal LAD. Diagonal branches were normal.
3. Left circumflex coronary artery was dominant and demonstrated a 40% distal stenosis. The obtuse marginal branches were normal.
4. Right coronary artery was small, nondominant and normal.
RESULTS
HEMODYNAMICS
1. Ventricular pullback aortic pressure 130 systolic, 80 diastolic, LV pressures 130 systolic, 16 end diastolic. Left ventricular end-diastolic pressure of 16 mmHg.
There is no systolic gradient noted across the aortic valve on ventricular pullback.
VENTRICULOGRAM
A ventriculogram was performed in standard 30-degree RAO position, which demonstrated a low normal left ventricular ejection fraction of 45% to 50%. There was no mitral regurgitation noted.
SELECTIVE CORONARY ANGIOGRAM
1. Left main coronary artery demonstrated luminal irregularities.
2. Left anterior descending was moderately calcified with a moderate eccentric 60% mid LAD stenosis. The distal LAD demonstrated a 40% stenosis, which appeared to be an intramyocardial portion of the distal LAD. Diagonal branches were normal.
3. Left circumflex coronary artery was dominant and demonstrated a 40% distal stenosis. The obtuse marginal branches were normal.
4. Right coronary artery was small, nondominant and normal.