Case of the week 0719: CMR guided revascularisation'

1
Case of the week 07-19 CMR guided
revascularisation.
History 72 yr old man with a 3 week history of
chest pain and shortness of breath presented in
cardiogenic shock with pulmonary edema, acute
renal failure, and VT. Initial management DC
electrical cardioversion, intra-aortic balloon
pump. Initial investigations Cardiac catheter
showed globally poor LV function, a significant
left main stem stenosis and three vessel disease.
SLIDE 1 of 2
2
Case of the week 07-19 CMR guided
revascularisation.
CMR Cine (top row) globally poor LV systolic
function. CMR LGE (middle) No late enhancement
suggesting extensive hibernation. Further
management High risk CABG undertaken. Outcome
Good symptomatic recovery. Renal function
normalized. Follow-up CMR (1 month post CABG)
(bottom) Substantially improved LV function.
Discussion The extent of the hibernating
myocardium pre-operatively is clearly defined
with the late enhancement imaging. The subsequent
recovery of LV function is seen in the
post-operative images in a patient who may
otherwise have been managed conservatively.
SLIDE 2 of 2
Dimitropoulos I, Crocker S, Dalrymple-Hay M,
Bellenger NG. Royal Devon and Exeter NHS
Foundation Trust, UK.