Eric Harlick Wins TCT Challenging Cases 2006 Award
This year’s TCT Challenging Cases Award went to Eric Harlick, MD, of the Toronto General Hospital. The award, now in its second year, recognizes cases that are unique and challenging.
“Some are successes, others are complications, but we learn from all of them,” said Gregg W. Stone, MD, Chairman of the Cardiovascular Research Foundation and Professor of Medicine at Columbia University Medical Center.
Harlick’s case involved a 30-year-old woman who had repair of a primum atrial septal defect and a cleft mitral valve in 1977. More recently, her cardiologist noted a coronary fistula to the left atrium and a moderate-to-severe mitral insufficiency.
The woman was referred to the Toronto Adult Congenital Heart Disease Center, where her case was reviewed. On examination, she was found to have NYHA Class I to Class II heart failure, moderate-to-severe mitral regurgitation, normal LV size and function, and abnormal flow through the interventricular septum.
The patient’s coronary angiograph showed anomalous left coronary artery flow extensively collateralized from the right coronary artery.
She was referred to the cath lab where a JL4 Fr guide catheter (Cordis) was advanced to the right pulmonary artery. The catheter was maneuvered to the left coronary artery ostium with right coronary artery injections.
Two Wizdom (Cordis) coronary wires were advanced into the left coronary artery guided by right coronary artery injections. With wire support, the tip of the JL4 guide was advanced past the minimal left main stenosis, which was used to anchor the vascular plug. The plug was then deployed in the left main stenosis.
The final angiogram showed a slowing of flow in the left anterior descending artery.
Two months following the procedure, the patient’s perfusion was found to be “probably normal.” More recently she was placed on metoprolol and aspirin.
Harlick said he would continue to follow the patient, and said she will likely need surgery for mitral regurgitation in the future.