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Number 07-19: CMR guided revascularisation

Case from: Dimitropoulos I, Crocker S, Dalrymple-Hay M, Bellenger NG. Royal Devon and Exeter NHS Foundation Trust, UK

History: 72 yr old man with a 3 week history of chest pain and shortness of breath presented in cardiogenic shock with pulmonary edema, acute renal failure and VT

Initial management: DC electrical cardioversion, intra-aortic balloon pump

Initial investigations: Cardiac catheter showed globally poor LV function, a significant left main stem stenosis and three vessel disease.

Cine CMR: (top row) globally poor LV systolic function).

CMR LGE: (middle) No late enhancement suggesting extensive hibernation.

Further management: High risk CABG undertaken.

Outcome: Good symptomatic recovery. Renal function normalized.

Follow-up CMR: (1 month post CABG): (bottom) Substantially improved LV function.

Discussion: The extent of the hibernating myocardium pre-operatively is clearly defined with the late enhancement imaging. The subsequent recovery of LV function is seen in the post-operative images in a patient who may otherwise have been managed conservatively.

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Handling editor was Mark Westwood