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Clinical Images
Iron Heart
Rolf Vogel, MD, PhD and Bernhard Meier, MD
March 2006
The medical history of a 59-year-old male, summarized by a selected frame of his most recent angiogram of the heart in a left anterior oblique projection (Figure 1), illustrates the contemporary device armamentarium to fight cardiac disease. Five years ago, the patient had presented to our hospital with dyspnea. The evaluation revealed severe mitral regurgitation caused by a prolapsing posterior leaflet and preserved left ventricular systolic function. Surgical mitral valve reconstruction was performed using a 32 mm annuloplasty ring (AR). In further evolution of his condition, the patient suffered from relapsing presyncope and 9 months later, he underwent resuscitation by defibrillation of ventricular fibrillation. The clinical assessment discovered nonsustained ventricular tachycardia, severely impaired left ventricular function with diffuse hypokinesia, and a nonstenotic plaque in the mid portion of the left anterior descending coronary artery. In light of amiodarone intolerance and paroxysmal atrial flutter/fibrillation, a dual chamber defibrillator system was implanted, featuring atrial and ventricular antitachycardia therapy: right atrial lead (RAL), right ventricular lead (RVL).
Four years later, after two ischemic cerebrovascular strokes, and in light of poorly controlled oral anticoagulation, transcatheter closure of the left atrial appendage (LAA) and the patent foramen ovale (PFO) was performed using a 25 mm (LAA) and a 35 mm (PFO) Amplatzer PFO occluder, respectively. Due to plaque progression, the mid left anterior descending coronary artery was treated by stent (S) implantation during the same session.
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