Fractional Flow Reserve in the Diagnosis of Ischemic Heart Disease in a Patient with Coronary Artery Ectasia

Abstract

Coronary artery ectasias (CAE) are diffuse dilatations of coronary artery segments with a diameter 1.5 times greater than the largest adjacent normal segment of the vessel. They are found in 0.3–5.0% of coronary angiography. Risk factors for CAE include atherosclerosis, previous percutaneous coronary interventions, arterial inflammation and connective tissue diseases. The diagnosis of CEA in a patient is a considerable diagnostic and therapeutic problem due to the unfavorable prognosis and the lack of guidelines. We present a case of a 69-year-old male patient with a history of retrosternal pain admitted to the clinic for the diagnosis of coronary artery disease. In coronary angiography, numerous ectases of the main coronary arteries and atherosclerotic lesions causing border stenosis of the left anterior descending (LAD), diagonal (2D) and marginal branch (OM). The heart team decided to assess the significance of the changes with the fractional flow reserve (FFR). The FFR was performed and haemodynamically insignificant stenoses of the ectatically dilated coronary arteries were found. The patient was qualified for conservative treatment.

Slow flow in ectatic dilated coronary arteries as the cause of sudden cardiac arrest during diagnostic coronary angiography

“…In previous studies, the prognosis of CAE patients with varies, but the accompanying slowed coronary flow causes angina complaints, which accounts for more frequent hospital admissions of patients and increases mortality in follow-up over several years [2]. The diagnosis and prognosis of these patients are further worsened by the coexistence of coronary atherosclerosis, so patients with coronary ectasias require special long-term follow-up [2,5].…”