Assessment and treatment of dynamic obstruction in anomalous right coronary artery using dynamic diastolic pressure gradient change during dobutamine challenge with rapid atrial pacing.
In anomalous right coronary artery (RCA), extravascular coronary compression results in dynamic obstruction which can cause effort angina as well as syncope. Measurement of dynamic intracoronary pressure gradient (DeltaP) change across the lesion using dobutamine challenge with rapid atrial pacing (RAP) can be used for assessment of dynamic obstruction in anomalous coronary artery. We report a case of anomalous origin of RCA which dynamic diastolic pressure gradient (DeltaP) was measured using this method. During dobutamine challenge with RAP, diastolic DeltaP significantly increased from 6 mm Hg at baseline to 13 mm Hg, and when diastolic DeltaP reached to 13 mm Hg, T wave inversion was observed, the chest pain was developed. After intracoronary stenting, diastolic DeltaP decreased to 2 mm Hg, chest pain was relieved, and T wave inversion was disappeared. The patient was asymptomatic at two months' follow-up.
Park
Ji Young
JY
Choi
Jae Woong
JW
Ryu
Sung Kee
SK
Cho
Yong Bum
YB
Lee
Soegjae
S
Song
Chang Sup
CS
D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D003330:Coronary Vessel Anomalies / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology / Q000601:surgery; D004280:Dobutamine; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
D004280:Dobutamine