Clin Res Cardiol (2021). 10.1007/s00392-021-01933-9

Youngest patient with refractory angina treated with coronary sinus reducer
A. Ajmi1, C. Mahnkopf1, W. Allakkis1, M. Oudeh1, M. Amami1, H. Mady1, S. Schnupp1
1II. Medizinische Klinik - Kardiologie, Angiologie, Pneumologie, REGIOMED-KLINIKEN GmbH, Coburg;
Abstract

Refractory angina affects a growing number of patients, which are considered not eligible to revascularization. Different therapeutic options are available for the treatment of this debilitating condition, all of them weren’t effective in the case of this patient. We report about the youngest patient (28 years), to our knowledge, with therapy-refractory angina successfully treated with Coronary Sinus Reducer (Neovasc Inc, Richmond, Canada). The patient suffered more than 3 years from severe angina symptoms which affected strongly her quality of life especially at this young age. Guidelines were respected in the treatment, which unfortunately didn’t improve the patient’s condition. The decision was taken to implant the CS-Reducer. This improved the symptomatic of the patient and totally reduced the hospitalization rate. 

HISTORY OF PRESENTATION

A 29 years old female with known CAD and a history of RCA PCI, was repeatedly hospitalized with severe disabling angina symptoms, at every minimal effort (CCS class III). 

PAST MEDICAL HISTORY

The patient has a history of obstructive CAD, dyslipidemia, hypertension, depression, asthma, overweight (BMI 39.4 kg/m2) and hypothyroidism. She was first diagnosed in 2018 when she was admitted with NSTEMI, and was treated with PCI and stent implantation to the RCA. The RPLD branch was occluded. The patient had been repeatedly hospitalized following the initial event due to severe angina in every minimal effort (Figure 1). The angina and repeated hospital admissions were despite administration of guideline-directed anti-angina therapy.  Because of disabling angina with very poor quality of life in this young patient, the decision was taken to implant a CS-Reducer.

INVESTIGATIONS

Coronary angiography revealed patent stent in the RCA and the known coronary with CTO of the RPLD (Figure 2). CMR stress test demonstrated a perfusion defect in the RIVA-area. The ejection fraction of the left ventricle was normal (60 %) with hypokinesia in the inferior wall.  Six-minute walk test (6MWT) was 300 m.

MANAGEMENT

The patient underwent successful CS Reducer implantation on October 2019. At 3 months follow up the patient described a clinically meaningful relief of her angina symptoms. She described angina only at strenuous or prolonged exercise (CCS class I), and a great improvement of her quality of life. 6MWT improved to 550 m. As a routine control after CS-Reducer implantation the patient underwent a CMR stress test, which didn’t reveal a perfusion defect in the RIVA area. At 6-months follow up the patient reported a very good quality of life without any physical disability.  

 

Conclusion

This clinical case project the complexity and difficulty in the treatment of patients with chronic refractory angina. Different interventional and pharmacological methods are available today to help those patients live a better life. The CS-Reducer seems to reduce the ischemic burden and angina symptoms.




https://dgk.org/kongress_programme/ht2021/P961.htm