Case reportAngina Associated With Left Main Coronary Artery Compression in Pulmonary Hypertension
Section snippets
Case 1
A 58-year-old man with a history of CREST syndrome (i.e., calcinosis, Raynaud syndrome, esophageal dysmotility, sclerodactyly, telangiectasia) and severe PAH presented complaining of angina. Transthoracic echocardiogram (TTE) indicated a severely dilated and dysfunctional right ventricle (RV), RV systolic pressure of 85 mm Hg, and a markedly enlarged pulmonary artery trunk (PAT) immediately adjacent to the take-off of the LMCA (Figure 1a). Computed tomography–gated coronary angiography (CT-CA)
Discussion
LMCA compression by an enlarged PA is a potentially life-threatening condition that may lead to refractory angina and persistent myocardial dysfunction.4 Given that 26% of fatalities attributed to PAH are related to sudden cardiac death,7 restoring coronary flow could potentially reduce mortality in PAH.
The incidence of LMCA compression in PAH is not well established. Although early reports estimated its incidence at 44%,8 subsequent studies showed an incidence ranging from 4.5% to 20%.9 This
References (18)
- et al.
United States validation of the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR)
J Heart Lung Transplant
(2008) - et al.
Left main coronary artery compression during primary pulmonary hypertension
Chest
(1997) - et al.
Stenting to reverse left ventricular ischemia due to left main coronary artery compression in primary pulmonary hypertension
Chest
(2001) - et al.
Likelihood of left main coronary artery compression based on pulmonary trunk diameter in patients with pulmonary hypertension
Am J Med
(2004) - et al.
Left main coronary trunk compression by dilated main pulmonary artery in atrial septal defectReport of three cases
J Thorac Cardiovasc Surg
(1992) - et al.
Extrinsic compression of the left main coronary artery by the pulmonary artery in patients with long-standing pulmonary hypertension
Am J Cardiol
(1999) - et al.
Preoperative prediction of early mortality and morbidity in coronary bypass surgery
Cardiovasc Surg
(2002) - et al.
Primary pulmonary hypertensionA national prospective study
Ann Intern Med
(1987) - et al.
Chest pain in association with pulmonary hypertension; its similarity to the pain of coronary disease
Circulation
(1952)
Cited by (25)
Lung transplantation for pulmonary hypertension with giant pulmonary artery aneurysm
2020, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :In patient 5, stenting of the left anterior descending coronary artery had been performed before transplantation. This was necessary due to compression of the vessel, a previously described problem in PAH with an enlarged PA.21-24 In the setting of lung transplantation, this is an important issue, because platelet inhibitors add a complicating factor to already highly complex circumstances. Thus, if stenting becomes necessary, it is important to avoid drug-eluting stents and the associated prolonged antiplatelet treatment.
Left Main Coronary Artery Compression in Patients With Pulmonary Arterial Hypertension and Angina
2017, Journal of the American College of CardiologyCitation Excerpt :Since the first reported autopsy of a patient with LMCA stenosis in 1957 (26), 94 additional clinical cases have been documented to date. Along with 11 small case series describing 46 patients (9,11,18,27–33), reports of LMCA stenosis have mostly been published as individual case studies. In a series of 26 PAH patients with angina, 7 (26.9%) had significant LMCA stenosis by extrinsic compression of the PA (11), supporting our findings.
A case of acute coronary syndrome caused by extrinsic compression of the left main coronary artery due to pulmonary hypertension
2010, Journal of Cardiology Cases
Supported by an American Lung Association postdoctoral fellowship and T32 research training grants (to V.A.d.J.P.), and by the Vera Moulton Wall Center for Pulmonary Vascular Disease (to F.H., J.A.F. and R.T.Z.).