Skip to main content

Novel physiological insight into a lotus root appearance in stable coronary artery diseases; Report of two cases

Cardiovascular Intervention and Therapeutics volume 31, pages 128–130 (2016)Cite this article

Abstract

So far physiological significance of multiple intraluminal channels separated by thin wall structures, so called “a lotus root appearance”, in an angiographic insignificant lesion in patients with suspected angina pectoris has remained undetermined. Here we present two cases that showed a “reverse visual-functional mismatch” phenomenon of a lotus root appearance using the indexes of myocardial fractional flow reserve and/or coronary flow velocity reserve. Our findings may provide a novel physiological insight into a lotus root appearance as a high possibility of critical functional stenosis in those with stable coronary artery diseases.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Terashima M, Awano K, Honda Y, Yoshino N, Mori T, Fujita H, et al. Images in cardiovascular medicine. “Arteries within the artery” after Kawasaki disease: a lotus root appearance by intravascular ultrasound. Circulation. 2002;106:887.

    Article  PubMed  Google Scholar 

  2. Toutouzas K, Karanasos A, Stathogiannis K, Synetos A, Tsiamis E, Papadopoulos D, et al. A honeycomb-like structure in the left anterior descending coronary artery: demonstration of recanalized thrombus by optical coherence tomography. JACC Cardiovasc Interv. 2012;5:688–9.

    Article  PubMed  Google Scholar 

  3. Kern MJ, Lerman A, Bech JW, De Bruyne B, Eeckhout E, Fearon WF, et al. Physiological assessment of coronary artery disease in the cardiac catheterization laboratory: a scientific statement from the American Heart Association Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiology. Circulation. 2006;114:1321–41.

    Article  PubMed  Google Scholar 

  4. Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van’ t Veer M, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009;360:213–24.

    CAS  Article  PubMed  Google Scholar 

  5. De Bruyne B, Pijls NH, Kalesan B, Barbato E, Tonino PA, Piroth Z, et al. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med. 2012;367:991–1001.

    Article  PubMed  Google Scholar 

  6. De Bruyne B, Fearon WF, Pijls NH, Barbato E, Tonino P, Piroth Z, et al. Fractional flow reserve-guided PCI for stable coronary artery disease. N Engl J Med. 2014;371:1208–17.

    Article  PubMed  Google Scholar 

  7. Meuwissen M, Chamuleau SA, Siebes M, de Winter RJ, Koch KT, Dijksman LM, et al. The prognostic value of combined intracoronary pressure and blood flow velocity measurements after deferral of percutaneous coronary intervention. Catheter Cardiovasc Interv. 2008;71:291–7.

    Article  PubMed  Google Scholar 

  8. Kern MJ, Samady H. Current concepts of integrated coronary physiology in the catheterization laboratory. J Am Coll Cardiol. 2010;55:173–85.

    Article  PubMed  Google Scholar 

  9. Michelis KC, Olin JW, Kadian-Dodov D, d’Escamard V, Kovacic JC. Coronary artery manifestations of fibromuscular dysplasia. J Am Coll Cardiol. 2014;64:1033–46.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Johnson NP, Tóth GG, Lai D, Zhu H, Açar G, Agostoni P, et al. Prognostic value of fractional flow reserve: linking physiologic severity to clinical outcomes. J Am Coll Cardiol. 2014;64:1641–54.

    Article  PubMed  Google Scholar 

  11. Park SJ, Kang SJ, Ahn JM, Shim EB, Kim YT, Yun SC, et al. Visual-functional mismatch between coronary angiography and fractional flow reserve. JACC Cardiovasc Interv. 2012;5:1029–36.

    Article  PubMed  Google Scholar 

  12. Nakamura M, Yamagishi M, Ueno T, Hara K, Ishiwata S, Itoh T, et al. Prevalence of visual-functionalmismatch regarding coronary artery stenosis in the CVIT-DEFER registry. Cardiovasc Interv Ther. 2014;29:300–8.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We are deeply indebted to Tetsuya Takeda, RT and Tatsushi Iwamoto, RT for their expert assistance in the preparation of figures. This research received no grant from any funding agency in the public, commercial or not-for-profit sectors.

Conflict of interest

The authors declare that there is no conflict of interest.

Author information

Affiliations

  1. Department of Cardiovascular Medicine, Sakakibara Heart Institute, 3-16-1 Asahi, Fuchu, Tokyo, 183-0003, Japan

    Makoto Suzuki, Atsushi Seki, Kei Nishikawa, Itaru Takamisawa, Tetsuya Tobaru & Tetsuya Sumiyoshi

Authors
  1. Makoto Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Atsushi Seki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kei Nishikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Itaru Takamisawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tetsuya Tobaru
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tetsuya Sumiyoshi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Makoto Suzuki.

About this article

Verify currency and authenticity via CrossMark

Cite this article

Suzuki, M., Seki, A., Nishikawa, K. et al. Novel physiological insight into a lotus root appearance in stable coronary artery diseases; Report of two cases. Cardiovasc Interv and Ther 31, 128–130 (2016). https://doi.org/10.1007/s12928-015-0325-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12928-015-0325-5

Keywords

  • Lotus root appearance
  • Fractional flow reserve
  • Coronary flow reserve
  • Optical conference tomography
  • Reverse visual-functional mismatch