presentation

1. CATH PRESENTATION
Chairperson
Prof. Dr. M A muqueet
Presenter
Dr. Md.Al-Amin
Phase B Resident, UCC,BSMMU

2. This week
• Total - 85 cases
• CAG – 51
• PTCA – 31
• TPM -2
• PPM - 1

3. Particulars of the patient
• Mrs .Moni Mala
• Age:50 year
• Housewife
• Married
• Rayganj, Sirajganj
• Date of admission: 31/12/21
• Date of CAG with PCI: 03/01/22

4. • He has been diagnosed as a case of
-Chronic Coronary Syndrome (Grade -2)
-Old MI(anteroseptal)
-Systemic Hypertension
-Type-2 DM

5. On general examination
• Co-operative,
• Decubitus on choice
• Pulse- 88 bpm, regular, normal volume and character
• BP- 120/80mmHg, no postural drop
• Jvp- not raised
• Temp – normal
• Edema - absent
• Other parameters are normal

6. Precordium
Inspection- No Visible impulse on apical region
No scar mark
Palpation-
-Apex beat is found on the left 5th intercostal space just
medial to midclavicular line
- There is no thrill
Auscultaion:
-First and second heart sounds are audible in all the
auscultatory areas
-No murmur or added sounds
- Clear lung bases

7. ECG on admission(31.12.21)

8. Investigation (31.12.21)
CK-MB 6.8 u/l
hs-Troponin -I 67.6 pg/ml
RBS 9.5 mmol/l
S.Craetinine 0.84mg/dl
S. electrolytes Na-143 ,K-3.9 ,Cl- 102
S.SGPT 33 U/l
HbA1c 6.6%
Echocardiography Not done

9. Investigations (01.01.22)
investigations findings
CBC HB 12 gm/dl
ESR 12 mm in 1st hr
WBC 7x109
Platelet 220x109
BT 3min
CT 6min
RBS 11.1mmol/l
S creatinine 0.82 mg/dl
S electrolytes Normal
HBsAg,Anti-HCV,Anti-HIV Negative
VDRL Non-reactive
Blood group "B" Positive

10. CAG

11. Post-PCI ECG(03.01.22)

12. Left Main Coronary Artery Disease
(LMCA)

13. Introduction
• Clinically significant LMCA disease is found in 3- 5%
of all patients undergoing CAG and 10- 30% of all
patients undergoing CABG
• LMCA diseas is associated with high morbidity and
mortality
• DES ,PCI for LMCA lesion has become technically
feasible and associated with long term favorable
clinical outcomes

14. Anatomy and physiology
• LMCA arises from left aortic sinus just below the sino-
tubular junction of the aortic root
• In aproximately, two-thirds of cases,it bifurcates into
LAD and LCX.In one-third cases it trifurcates
intoLAD,LCX and Ramus Intermedius
• LMCA supplies about 75% of the left ventricle
• LMCA has an average lentgh 10.8mm ,diameter 4.9mm
and with an average branches angle 86.7°
• Anatomically LMCA is devided into 3 regions,the
ostium,midshaft and distal bifurcation

15. • Histologycally,ostial portion resembles to aorta,being
rich in smooth and elastic fibers
• Distal bifurcation part of LMCA is the most common
site of atheromatous plaque formation(low shear flow)
than bifurcation carina
• In minimal LMCA disease,atheromatous plaque type is
intimal thickening
• Significant lesion shows complex plaque,fibroatheroma
with thin cap,surface rupture,fissure and intra-plaque
haemorrhage

17. Definition of significant LMCA stenosis
• Angiographic LMCA diameter <50%
• Fractional flow reserve (FFR) <0.80
• IVUS LMCA minimal luminal area (MLA)
<4.9mm

22. PCI of LMCA
• PCI of LM ostial and shaft lesion can
beperformed safely ,and is associated with
excellent short term and long term outcomes
• PCI to LM bifurcation lesion is challenging and is
associated with high rate of adverse clinical
evevents
• Stenting strategy in LM bifurcation lesion
depends on several clinical and anatomical
factors

25. Multi-Vessel Disease PCI