Left ventricular viability in a patient with heart failure due to left main stem stenosis, predicted by SPECT and gadolinium-enhanced magnetic resonance but not by dobutamine stress echocardiography.
2006
A 54-year-old woman with occlusive disease of the distal
abdominal aorta was referred for pre-operative risk
assessment, and was diagnosed with severe impairment
of the left ventricular function due to left main stem
coronary artery stenosis. Low-dose dobutamine stress echocardiography did
not demonstrate contractile reserve, while gadolinium enhanced
cardiac magnetic resonance (CMR) suggested
viability of the left ventricle. The patient underwent
coronary bypass grafting, and had an uncomplicated
post-operative course, with improvement of the left ventricular
ejection fraction from the initial 20% to 44%
after four months. The value of CMR in determining
myocardial viability in left main stem stenosis has not
previously been reported.
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