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Double Reducer implantation in the coronary venous system for treatment of refractory angina: a case report

BACKGROUND: The coronary sinus (CS) Reducer can be considered for the treatment of refractory angina in patients unsuitable for coronary revascularization, but its effect can be influenced by the significant heterogeneity in the anatomy of the cardiac venous system. CASE SUMMARY: We report the case...

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Autores principales: Picchi, Andrea, Misuraca, Leonardo, Calabria, Paolo, Limbruno, Ugo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9168669/
https://www.ncbi.nlm.nih.gov/pubmed/35673278
http://dx.doi.org/10.1093/ehjcr/ytac210
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author Picchi, Andrea
Misuraca, Leonardo
Calabria, Paolo
Limbruno, Ugo
author_facet Picchi, Andrea
Misuraca, Leonardo
Calabria, Paolo
Limbruno, Ugo
author_sort Picchi, Andrea
collection PubMed
description BACKGROUND: The coronary sinus (CS) Reducer can be considered for the treatment of refractory angina in patients unsuitable for coronary revascularization, but its effect can be influenced by the significant heterogeneity in the anatomy of the cardiac venous system. CASE SUMMARY: We report the case of a 70-year-old woman with recurrent episodes of rest angina refractory to optimal medical therapy [Canadian Cardiovascular Society (CCS) Class IV] and inducible ischaemia in a large myocardial territory. Given the diffuse and peripheral nature of the coronary disease, the patient was considered ineligible for percutaneous or surgical revascularization and she was regarded as a good candidate for a CS occluder. Since coronary venous angiography showed the middle cardiac vein (MCV) to be at least as relevant as the CS, successful implantation of two devices, one in the CS and the second in the MCV, was performed. At 6-month follow-up, the patient reported a significant improvement in angina, resulting in a reduction of the CCS class from Grades IV to III. DISCUSSION: In patients affected by refractory angina and regarded as good candidates for Reducer implantation, a thorough comprehension of the cardiac venous pathway drainage is of pivotal importance to guarantee the therapeutic success of the procedure. In this patient, since the CS and the MCV seemed to contribute equally to coronary venous drainage, Reducer implantation in both vessels allowed to obtain a significant improvement of symptoms. The clinical effectiveness of this strategy needs to be validated in randomized clinical trials.
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spelling pubmed-91686692022-06-06 Double Reducer implantation in the coronary venous system for treatment of refractory angina: a case report Picchi, Andrea Misuraca, Leonardo Calabria, Paolo Limbruno, Ugo Eur Heart J Case Rep Case Report BACKGROUND: The coronary sinus (CS) Reducer can be considered for the treatment of refractory angina in patients unsuitable for coronary revascularization, but its effect can be influenced by the significant heterogeneity in the anatomy of the cardiac venous system. CASE SUMMARY: We report the case of a 70-year-old woman with recurrent episodes of rest angina refractory to optimal medical therapy [Canadian Cardiovascular Society (CCS) Class IV] and inducible ischaemia in a large myocardial territory. Given the diffuse and peripheral nature of the coronary disease, the patient was considered ineligible for percutaneous or surgical revascularization and she was regarded as a good candidate for a CS occluder. Since coronary venous angiography showed the middle cardiac vein (MCV) to be at least as relevant as the CS, successful implantation of two devices, one in the CS and the second in the MCV, was performed. At 6-month follow-up, the patient reported a significant improvement in angina, resulting in a reduction of the CCS class from Grades IV to III. DISCUSSION: In patients affected by refractory angina and regarded as good candidates for Reducer implantation, a thorough comprehension of the cardiac venous pathway drainage is of pivotal importance to guarantee the therapeutic success of the procedure. In this patient, since the CS and the MCV seemed to contribute equally to coronary venous drainage, Reducer implantation in both vessels allowed to obtain a significant improvement of symptoms. The clinical effectiveness of this strategy needs to be validated in randomized clinical trials. Oxford University Press 2022-05-25 /pmc/articles/PMC9168669/ /pubmed/35673278 http://dx.doi.org/10.1093/ehjcr/ytac210 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Case Report
Picchi, Andrea
Misuraca, Leonardo
Calabria, Paolo
Limbruno, Ugo
Double Reducer implantation in the coronary venous system for treatment of refractory angina: a case report
title Double Reducer implantation in the coronary venous system for treatment of refractory angina: a case report
title_full Double Reducer implantation in the coronary venous system for treatment of refractory angina: a case report
title_fullStr Double Reducer implantation in the coronary venous system for treatment of refractory angina: a case report
title_full_unstemmed Double Reducer implantation in the coronary venous system for treatment of refractory angina: a case report
title_short Double Reducer implantation in the coronary venous system for treatment of refractory angina: a case report
title_sort double reducer implantation in the coronary venous system for treatment of refractory angina: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9168669/
https://www.ncbi.nlm.nih.gov/pubmed/35673278
http://dx.doi.org/10.1093/ehjcr/ytac210
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