Safety of Extracorporeal Shockwave Myocardial Revascularization (ESMR) in Patient with a Mechanical Prosthetic Valve.

Gianluca Alunni

doi:10.31579/2641-0419/009

Abstract

Safety of Extracorporeal Shockwave Myocardial Revascularization (ESMR) in Patient with a Mechanical Prosthetic Valve.

Highlights

Introduction and highlightsThe number of patients with refractory angina without revascularization options is increasing
According to the last American College of Cardiology/American Heart Association (ACC/AHA) guidelines on the management of chronic stable angina, the objective of the treatment should be the resolution of angina attacks, the reduction of the numbers of hospitalizations and the carrying out of normal daily activities without symptoms [1-6]
The Extracorporeal Shockwave Myocardial Revascularization therapy (ESMR) were applicated with a commercially available cardiac shock wave generator system (Cardiospect TM, Medispec, Germantown, MD) under echocardiographic guidance (Figure 1.A and B): through a cardiac ultrasound imaging system, we look at this area and these measurements are calibrated into the shockwave applicator head to ensure the position of the focal treatment zone, so using an electrocardiographic R-wave gating, shockwaves are delivered through the applicator to the sub-endocardial myocardium of the ischemic area

Summary

Introduction and highlights

The number of patients with refractory angina without revascularization options is increasing. Extracorporeal Shockwave Myocardial Revascularization therapy (ESMR) is a non-invasive treatment and several studies have demonstrated its safety and its efficacy in patients with refractory angina (RA) to improve myocardial perfusion and exercise capacity reducing symptoms by the application shockwaves (SW) on the culprit ischemic area of the heart under echocardiographic guidance [7-26]. In 2013, for stress angina recurrence, a myocardial single-photon emission computed tomography (SPECT) with pharmacological stress (Dipyridamole) was performed, with the evidence of modest inducible ischemia in inferior cardiac wall (SRS 3, SSS 9, SDS 6), without CAD progression at the coronary angiography. For this reason, in 2014, we decided to treat the patient with shockwaves therapy

ESMR protocol

Case presentation

Echocardiographic prosthesis control

Conclusion