Percutaneous coronary intervention in left main coronary artery disease in a patient with hemophilia B
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CASE REPORT
Percutaneous coronary intervention in left main coronary artery disease in a patient with hemophilia B Er Arzu • Altekin R. Emre • Kabukcu Mehmet Yalcinkaya Selim • Deger Necmi
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Received: 20 May 2010 / Accepted: 12 October 2010 / Published online: 14 January 2011 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2011
Abstract A 77-year-old male patient with the diagnosis of hemophilia presented himself at the cardiology clinic with unstable angina and a coronary angiography was planned. Factor IX was prepared before the procedure due to the risk of hemorrhage. Critical lesions were detected in the left main coronary artery (LMCA) and the procedure was performed on the LMCA in the same session. No complication of hemorrhage developed. Having rarely found in literature on any procedure on the LMCA without factor IX infusion we wished to report on this rare case of concurrent hemophilia B and acute coronary syndrome. Keywords
Hemophilia Coronary intervention Stent
Introduction The risk of hemorrhage at the site of access is increased following percutaneous coronary interventions in hemophilia patients. Concentrated factor IX infusion with the aim of reducing the risk of hemorrhage increases the risk of stent thrombosis. In these patients, surgical interventions cause major problems with regard to hemorrhage and hemostasis. In this paper, we present a the case of a patient who had severe unstable angina, as well as left main coronary artery disease. Case report A 77-year-old male patient who had no history of diabetes mellitus, hypertension or hyperlipidemia and had no E. Arzu A. R. Emre K. Mehmet (&) Y. Selim D. Necmi Department of Cardiology, Akdeniz University Medicine Faculty Hospital, Antalya, Turkey e-mail: [email protected]
history of smoking had been under follow-up for 25 years with the diagnosis of hemophilia B. He presented himself at the cardiology clinic complaining of severe chest pain. It was learnt that he had been given medical treatment which included acetylsalicylic acid, isosorbide mononitrate and metoprolol due to the presence of pressure-like exertional angina for a long time, and the pain had changed to a long standing resting angina in the last 24 h. A coronary angiography was initially recommended, before having realized that the patient had a concominant hemophilia B. According to his medical history, he had been diagnosed with hemophilia B in 1984, and factor IX replacements were admisnistered due to an intracerebral hematoma in 1997, several times prior to tooth extractions, and lastly, 2 months prior to his admission due to gingival hemorrhage. On physical examination, the blood pressure was 150/ 80 mmHg; he had a 1/6 systolic murmur on cardiovascular system examination and his pulmonary examination was normal. There was no hepatosplenomegaly. ECG findings were: sinus rhythm 70 beats/min, widespread ST depressions and biphasic T wave on all derivations (Fig. 1). On chest X-ray, the cardiothoracic index was in the upper limit, and the l
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