Extrinsic Compression of the Left Main Coronary Artery by Atrial Septal Defect

doi:10.1016/j.athoracsur.2008.05.046

The Annals of Thoracic Surgery

Volume 86, Issue 6, December 2008, Pages 1987-1989

https://doi.org/10.1016/j.athoracsur.2008.05.046 Get rights and content

On rare occasions, extrinsic compression of the coronary artery can cause significant stenosis. We report a 42-year-old woman who was referred to our hospital for surgical repair of atrial septal defect. Cardiac 64-slice multi-detector computed tomography before the operation revealed the extrinsic compression of the proximal left main coronary artery by the marked dilatation of pulmonary trunk. The patient eventually underwent atrial septal defect closure and coronary artery bypass simultaneously. Four months after the operation, multi-detector computed tomographic scan revealed reduction of pulmonary trunk diameter and resolution of left main coronary artery narrowing.

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Prolonged left-to-right shunt in patients with ASD promotes right heart dilatation and pulmonary vascular changes. Extrinsic compression of the LMCA by an enlarged pulmonary trunk in patients with long-standing pulmonary hypertension has been previously reported [1, 2, 3]. Although LMCA narrowing is generally secondary to atherosclerotic disease, it is important to differentiate extrinsic compression from atherosclerosis in a patient with long-standing pulmonary hypertension. The optimal

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Citation Excerpt :
Atrial septal closure with or without aortocoronary bypass is recommended. Aortocoronary bypass is again controversial as some case reports suggest a decrease in pulmonary size and a decrease in compression of a left main coronary artery after surgical closure of atrial septal defect [14]. However, several reports have shown the efficacy of coronary artery bypass in left main compression [2,15].
External compression of left main coronary artery (LMCA) by dilated pulmonary artery is a rare and less known phenomenon.
To find incidence and associated angiographic findings of LMCA compression by a dilated pulmonary artery in adult patients with an Atrial septal defect (ASD).
It was a retrospective observational study done in 55 patients with ASD and age more than 35 years. All patients underwent coronary angiogram along with cardiac catheterization to look for hemodynamic parameters and status of the epicardial coronary artery. Patients with significant LMCA compression underwent computed tomography and intravascular imaging to confirm significant compression and rule out atherosclerotic stenosis. Patients with and without LMCA compression were compared to find any causation, and patients with LMCA compression were followed up after the final consensus of management.
As compared to patients without LMCA compression, significant LMCA compression was found in 4 (7.27%) of patients and associated with reduced ejection fraction (46.3 ± 10.3% vs 60 ± 2.0%; p-value 0.001), increased pulmonary artery diameter (55 ± 14.5 mm vs 24.9 ± 4.7 mm; p-value <0.01), increased pulmonary artery to aortic diameter ratio (2.6 ± 0.8 vs 1.2 ± 0.2; p-value <0.01) and raised mean pulmonary artery pressure (mPAP) (43.3 ± 5.1 mmHg vs 24.5 ± 6.1; p-value 0.003). Patients underwent surgical correction or LMCA stenting or followed up medically.
LMCA compression is rarely seen in patients with an atrial septal defect and is associated with a reduced ejection fraction, increased pulmonary artery diameter, increased pulmonary artery/aortic diameter ratio, and raised mPAP. Treatment modalities like medical management, percutaneous intervention by stenting, and surgical correction play an important role in management.
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Case reportExtrinsic Compression of the Left Main Coronary Artery by Atrial Septal Defect

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J Thorac Cardiovasc Surg

Int J Cardiol

Am J Cardiol

Am Heart J

Case report
Extrinsic Compression of the Left Main Coronary Artery by Atrial Septal Defect