Delayed improvement of myocardial function after recanalization of a chronic coronary occlusion in a patient with intractable heart failure.

Abstract

This case report describes the delayed improvement of left ventricular function by recanalization of an occluded coronary artery in a patient with intractable heart failure and three-vessel disease. The left anterior descending coronary artery was occluded distal to the first septal branch, the dominant right coronary artery had a diameter stenosis of 70-80% in its middle part, and the circumflex artery a proximal stenosis of 50%. Ventriculography revealed globally depressed left ventricular function with an ejection fraction of 16%. Successful recanalization and angioplasty of the occluded coronary artery resulted in a slow improvement of left ventricular function. Ultimate recovery of systolic performance (increase of ejection fraction from 16% to 48-51%) required more than half a year. It is speculated that stunned myocardium following chronic ischaemia is a consequence of vascular dysfunction.