Subclavian steal syndrome presenting as recurrent pulmonary oedema associated with acute left ventricular diastolic dysfunction

• Published in: Cardiovascular revascularization medicine 2013, Vol.14 (1), p.45-48
• Main Authors: Mangialavori, Giuseppe, Ballo, Piercarlo, Michelagnoli, Stefano, Ercolini, Leonardo, Barbanti, Enrico, Passuello, Franco, Abbondanti, Alessandro, Consoli, Lorenzo, Chechi, Tania, Fibbi, Veronica, Nannini, Marco, Chiodi, Leandro, Zuppiroli, Alfredo
• Format: Article
• Language: English
• Subjects: Acute Disease; Aged, 80 and over; Angioplasty, Balloon - instrumentation; Cardiovascular; Cardiovascular Agents - therapeutic use; Coronary Artery Bypass - adverse effects; Coronary-Subclavian Steal Syndrome - diagnosis; Coronary-Subclavian Steal Syndrome - etiology; Coronary-Subclavian Steal Syndrome - therapy; Diastole; Diuretics - therapeutic use; Echocardiography, Doppler, Color; Female; Humans; Pulmonary Edema - diagnosis; Pulmonary Edema - etiology; Pulmonary Edema - therapy; Pulmonary oedema; Recurrence; Severity of Illness Index; Stents; Stroke Volume; Subclavian steal syndrome; Tissue doppler; Treatment Outcome; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - physiopathology; Ventricular Dysfunction, Left - therapy; Ventricular Function, Left
• ISSN: 1553-8389; 1878-0938
• DOI: 10.1016/j.carrev.2012.08.009

Abstract Subclavian steal syndrome typically presents as angina in patients with internal mammary artery grafts. Atypical clinical presentations have been rarely described. We report an unusual case of subclavian steal syndrome presenting as pulmonary oedema with acute left ventricular diastolic dysfunction and preserved ejection fraction in a patient with internal mammary artery graft and severe stenosis of the proximal left subclavian artery. After successful angioplasty and stenting of subclavian artery, the patient remained asymptomatic for six months, but then experienced acute diastolic dysfunction and recurrent pulmonary oedema associated with critical subclavian in-stent restenosis with stent deformation. This report points out that, in patients with internal mammary-to-LAD grafts, subclavian steal syndrome may present as acute left ventricular diastolic dysfunction and pulmonary oedema even in the presence of normal ejection fraction.