Conservative Medication Follow-up for Over 20 Years of a Patient With Ischemic Heart Disease After Diagnosis of Chronic Total Occlusion of the 3 Main Coronary Arteries

Shinichiro Tanaka; Chiharu Yokoyama; Itta Kawamura; Nobuhiro Takasugi; Tomoki Kubota; Hiroaki Ushikoshi; Takuma Aoyama; Masanori Kawasaki; Kazuhiko Nishigaki; Genzou Takemura; Shinya Minatoguchi

doi:10.1253/circj.72.1205

Case Report

Conservative Medication Follow-up for Over 20 Years of a Patient With Ischemic Heart Disease After Diagnosis of Chronic Total Occlusion of the 3 Main Coronary Arteries

Shinichiro Tanaka, Chiharu Yokoyama, Itta Kawamura, Nobuhiro Takasugi, Tomoki Kubota, Hiroaki Ushikoshi, Takuma Aoyama, Masanori Kawasaki, Kazuhiko Nishigaki, Genzou Takemura, Shinya Minatoguchi

Author information

Shinichiro Tanaka
Second Department of Internal Medicine, Gifu University Graduate School of Medicine
Chiharu Yokoyama
Second Department of Internal Medicine, Gifu University Graduate School of Medicine
Itta Kawamura
Second Department of Internal Medicine, Gifu University Graduate School of Medicine
Nobuhiro Takasugi
Second Department of Internal Medicine, Gifu University Graduate School of Medicine
Tomoki Kubota
Second Department of Internal Medicine, Gifu University Graduate School of Medicine
Hiroaki Ushikoshi
Second Department of Internal Medicine, Gifu University Graduate School of Medicine
Takuma Aoyama
Second Department of Internal Medicine, Gifu University Graduate School of Medicine
Masanori Kawasaki
Second Department of Internal Medicine, Gifu University Graduate School of Medicine
Kazuhiko Nishigaki
Second Department of Internal Medicine, Gifu University Graduate School of Medicine
Genzou Takemura
Second Department of Internal Medicine, Gifu University Graduate School of Medicine
Shinya Minatoguchi
Second Department of Internal Medicine, Gifu University Graduate School of Medicine

Keywords: Coronary artery disease, Drugs, Ischemia, Occlusion

JOURNAL FREE ACCESS

2008 Volume 72 Issue 7 Pages 1205-1209

DOI https://doi.org/10.1253/circj.72.1205

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Abstract

A 48-year-old man suffered from acute coronary syndrome in 1978. Coronary angiography was performed at that time and showed 99% stenosis of the right coronary artery, 100% of the left circumflex branch, and 50% of the left ascending artery. He received conservative therapy. Five years later (ie, 1983), coronary angiography showed complete occlusions of the 3 major coronary arteries. Rich collateral circulation had developed distal to all 3 major coronary trees. The patient and his family rejected invasive therapies such as coronary-artery bypass graft or percutaneous coronary intervention. Cardiac catheterizations were performed in 1996, 2001, and 2007, but angiographic follow-up studies showed no change in either the coronary atherosclerosis or the collateral circulation. The left ventricular ejection fraction has been maintained at >60%. During the 20-year follow-up, he has had refractory angina, but has not suffered from acute coronary syndrome, congestive heart failure, or critical arrhythmia. (Circ J 2008; 72: 1205 -1209)

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