case_images: PMC11739284_01
case_images: Electrocardiogram (ECG). (A) Patient's pre-surgical ECG. (B) Patient develops ventricular fibrillation after shock. (C) ECG after ECMO implantation: poor R-wave progression in the anterior wall leads, abnormal Q-waves in the high lateral wall leads, T-wave alterations, and a decrease in the voltage of the QRS wave in the left thoracic lead. (D) ECG of the patient one month after receiving unroofing.
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case_images: F1
case_images: Subsequently, the patient manifested respiratory and circulatory failure, and the electrocardiogram (ECG) demonstrated ventricular fibrillation (Figure 1). At this time, the patient's ECG revealed myocardial ischemia (Figure 1), and the cardiac ultrasound revealed diminished myocardial contractile motion in the left ventricle with a left ventricular ejection fraction (LVEF) of 30% and a pulmonary artery pressure of 61 mmHg.
case_images: Clinical images. (A-C) Multiplanar reformat image showing an acute takeoff angle (<45 ) of the inter-arterial left main coronary artery (LM) originating from the right coronary sinus. (D-F) Multi-angle coronary angiography showing LM originating from the upper part of the right coronary sinus, with an eccentric stenosis of 80%-90%.
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case_images: F2
case_images: CTA, and the image suggested that the LM originated from the right coronary sinus and traveled between the aorta and the pulmonary artery. Coronary angiography suggested that the left coronary artery originated from the upper part of the right coronary sinus, with eccentric stenosis of 80%-90% from the opening of the LM to the proximal vessel lumen, and no notable stenosis was found in the rest of the vessels (Figure 2).
case_images: Echocardiographic data. (A-C) LM compression is relieved during intra-aortic balloon counter-pulsation (IABP), the LM internal diameter increases, the peak diastolic coronary flow (Vpd) velocity drops, and the LM pressure difference decreases. The LM is compressed again after stopping IABP. (D,E) After starting IABP therapy, this patient's brain natriuretic peptide (BNP) levels decreased and her left ventricular ejection fraction (LVEF) increased.
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case_images: F3
case_images: Also, the patient's cardiac function improved, the brain natriuretic peptide (BNP) level decreased, and the LVEF increased after IABP therapy (Figure 3).
case_images: The timeline of the patient's case.
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case_images: F4
case_images: Figure 4 summarised the patient's treatment history by way of a timeline.