An Intermittent Kinking of an Artery


Dr. Pedro Cazabon believes a team effort is important when it comes to medicine, and he encourages patients to pursue multidisciplinary approaches when it comes to rare or confusing symptoms.

Years back, he recalled, he was following a patient with rheumatoid arthritis, which included some pulmonary nodules that required annual CT scans for follow-up. “He developed a pattern of chest pain with exertion suspicious for a cardiac blockage,” he said. “We evaluated him for heart disease.”

But the angiogram was normal. A subsequent CT scan of the chest suggested, however, a rare congenital (present at birth) abnormality of the pericardium (the membrane enclosing the heart).

“He had a gap in the sack around the heart,” Cazabon said.

The diagnosis became clear when the patient’s radiologist called Cazabon and reported the faint finding she saw, incidentally, on the CT scan. “She was able to see his recent visits for chest pain in our electronic medical record, which resulted in a focused MRI to confirm the abnormality,” he said.

The doctors suspected this was causing an intermittent kinking of the patient’s main coronary artery, triggered only when he exerted himself. Once the congenital abnormality was discovered, it was corrected with surgery.  

“He underwent a removal of the pericardium and has been pain-free ever since,” Cazabon said. “His prognosis is very good for having no further complications.”

It was a confounding case, and solidified the importance of working with physicians in other fields, according to Cazabon. “It was a great team effort including the patient, primary care, radiology, rheumatology, cardiology and the cardiac surgeon.”

In the meantime, Cazabon continues to pursue both clinical and administrative duties at Ochsner.       

“My role allows me to work on the systems that help people get timely access and resources for their medical needs in primary care and beyond,” he says. “Helping them navigate our health system and get the care they need brings me a lot of professional satisfaction. Our team continually works to improve in patient experience, which we hope will result in better engagement by patients in their care.”