PMC3271297_01
Initial 12-lead electrocardiogram showing: ST depression in V4-6 and II, III, aVF leads, QS pattern in V1-3 leads, ST elevation in aVR and VPC bigeminy.
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F1
An electrocardiogram showed ST depression in V4-6 and II, III, aVF leads, QS pattern in V1-3 leads, ST elevation in aVR, and VPC bigeminy (Fig. 1).
Chest x-ray. (A) Anteroposterior radiograph of the chest at admission showing alveolar-interstitial infiltrates limited to the right lung. (B) Anteroposterior radiograph of the chest post-successful PCI showing a unilateral homogenous pulmonary opacity occupying the right lobe, and right pleural effusion. (C) Posteroanterior radiograph of the chest at discharge showing complete resolution of the unilateral pulmonary edema.
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F2
Chest X-ray revealed alveolar-interstitial infiltrates limited to the right lung (Fig. 2A). Serial chest Radiography obtained for 3 days after the PCI demonstrated aggravation of a right-sided pulmonary edema (Fig. 2B). Repeat chest Radiography showed complete resolution of the unilateral edema (Fig. 2C).
Transthoracic echocardiography on admission and four days later after percutaneous coronary intervention (PCI). Echocardiography on admission showing global hypokinesia, mild mitral regurgitation (MR) and left atrium (LA) enlargement (LA volume, 54 mL) (A, B). Four days later after PCI, left ventricular contraction and LA enlargement have improved (LA volume, 34 mL), and MR has resolved (C, D).
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F3
Echocardiography at admission disclosed an ejection fraction of approximately 40% with global hypokinesia and mild MR (Fig. 3A). MR was completely resolved (Fig. 3B).
Coronary artery angiography during the primary percutaneous coronary intervention. (A) Left coronary angiography showing significant stenosis from the distal left main coronary artery to the mid left anterior descending artery with thrombolysis in myocardial infarction (TIMI) 2 flow and total occlusion at the ostium of the left circumflex artery with TIMI 0 flow. (B) Final coronary angiography showing successful revascularization without periprocedural complications.
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F4
This revealed significant stenosis from the distal left main coronary artery (LM) to the mid left anterior descending artery (LAD) with thrombolysis in myocardial infarction (TIMI) grade 2 flow and total occlusion at the ostium of the left circumflex artery (LCX) with TIMI grade 0 flow (Fig. 4A). PCI was performed using a 2.0 x 20 mm conventional balloon catheter followed by deployment of an Endeavor Resolute 2.75 x 18 mm stent at mid LAD, a Promus Element 3.5 x 28 mm stent at LM to proximal LAD, and an Endeavor Resolute 2.5 x 14 mm stent at proximal LCX with post-stent TIMI grade 3 flow (Fig. 4B).
Computed tomography scan revealing consolidation and ground-glass opacity in the dependent portion of the right lung, with pleural effusion limited to the right lung.
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F5
A computed tomography scan performed on the third day after PCI revealed: a consolidation and ground-glass opacity in the dependent portion of the right lung, pleural effusion limited to the right lung, mild cardiomegaly with regurgitation of contrast material into the inferior vena cava, and no evidence of pulmonary artery and vein occlusion (Fig. 5).