Amiodarone is one of the commonly used anti-arrhythmic agents with well-recognized chronic pulmonary toxicity. We present our experience of a patient with a fatal outcome after coronary artery bypass grafting and a short course of amiodarone treatment with a low total cumulative dose for the treatment of postoperative atrial fibrillation. Necropsy revealed diffuse pulmonary damage due to acute amiodarone lung toxicity.
A middle age woman with known ischemic heart disease and old stents in proximal left anterior descending coronary artery (LAD) was admitted to Coronary Care Unit with acute coronary syndrome. The coronary angiography showed one vessel disease with significant restenosis within the previously implanted stents. The lesion was tough and remained undilatable despite high pressure balloon inflation. Eventually, the balloon ruptured creating a massive dissection of the LAD beginning immediately after the distal part of the undilatable lesion. We proceeded with a challenging ad hoc rotational atherectomy of the lesion and finally stenting of the lesion. In-stent restenosis many years after stent implantation is considered to be mainly due to neoatheromatosis compared to intimal hyperplasia, making lesion treatment more difficult and unpredictable.
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