title: Subclavian steal syndrome presenting as recurrent pulmonary oedema associated with acute left ventricular diastolic dysfunction.
abstract: Subclavian steal syndrome typically presents as angina in patients with internal mammary artery grafts. Atypical clinical presentations have been rarely described. We report an unusual case of subclavian steal syndrome presenting as pulmonary oedema with acute left ventricular diastolic dysfunction and preserved ejection fraction in a patient with internal mammary artery graft and severe stenosis of the proximal left subclavian artery. After successful angioplasty and stenting of subclavian artery, the patient remained asymptomatic for six months, but then experienced acute diastolic dysfunction and recurrent pulmonary oedema associated with critical subclavian in-stent restenosis with stent deformation. This report points out that, in patients with internal mammary-to-LAD grafts, subclavian steal syndrome may present as acute left ventricular diastolic dysfunction and pulmonary oedema even in the presence of normal ejection fraction.
authors.affiliation: Department of Cardiology, S. Maria Annunziata Hospital, Florence, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mangialavori
authors.forename: Piercarlo
authors.initials: P
authors.lastname: Ballo
authors.forename: Stefano
authors.initials: S
authors.lastname: Michelagnoli
authors.forename: Leonardo
authors.initials: L
authors.lastname: Ercolini
authors.forename: Enrico
authors.initials: E
authors.lastname: Barbanti
authors.forename: Franco
authors.initials: F
authors.lastname: Passuello
authors.forename: Alessandro
authors.initials: A
authors.lastname: Abbondanti
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Consoli
authors.forename: Tania
authors.initials: T
authors.lastname: Chechi
authors.forename: Veronica
authors.initials: V
authors.lastname: Fibbi
authors.forename: Marco
authors.initials: M
authors.lastname: Nannini
authors.forename: Leandro
authors.initials: L
authors.lastname: Chiodi
authors.forename: Alfredo
authors.initials: A
authors.lastname: Zuppiroli
mesh_terms: D000208:Acute Disease; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000295:instrumentation; D002317:Cardiovascular Agents / Q000627:therapeutic use; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D058686:Coronary-Subclavian Steal Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D004232:Diuretics / Q000627:therapeutic use; D018618:Echocardiography, Doppler, Color; D005260:Female; D006801:Humans; D011654:Pulmonary Edema / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D012008:Recurrence; D012720:Severity of Illness Index; D015607:Stents; D013318:Stroke Volume; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D016277:Ventricular Function, Left
chemical_list: D002317:Cardiovascular Agents; D004232:Diuretics