El stent en la compresión del tronco coronario izquierdo en la hipertensión pulmonar primaria

doi:10.1016/S0300-8932(04)77171-7

Revista Española de Cardiología

Volume 57, Issue 7, 2004, Pages 695-698

https://doi.org/10.1016/S0300-8932(04)77171-7 Get rights and content

La hipertensión arterial pulmonar primaria se asocia frecuentemente con dolor torácico de características anginosas cuya etiología es incierta. La compresión extrínseca del tronco común de la coronaria izquierda por la arteria pulmonar es una causa tratable de angina que debe ser considerada en estos pacientes. Se presenta el caso de una paciente con hipertensión pulmonar primaria, clínica de angina y compresión extrínseca del tronco común coronario izquierdo por parte de la arteria pulmonar que fue tratada con un implante de stent directo.

Primary pulmonary hypertension is often associated with angina-like chest pain of uncertain etiology. Left main coronary artery compression by the pulmonary artery is a treatable cause of angina and should be considered in these patients. We describe a patient presenting with primary pulmonary hypertension, clinical angina and extrinsic compression of the left main coronary artery by the pulmonary artery, who was treated with direct stenting.

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Cited by (26)

Two rare conditions in an Eisenmenger patient: Left main coronary artery compression and Ortner's syndrome due to pulmonary artery dilatation
2013, Heart and Lung: Journal of Acute and Critical Care
The left-main coronary artery extrinsic compression due to enlarged pulmonary artery has been described in several case series. Ortner's syndrome is also a rare condition in some cardiovascular disorders. There have been no reports about these two rare conditions in the same patient. Hence, we report a very rare case of an Eisenmenger patient with severe pulmonary hypertension and dilated pulmonary artery which has compressed the left main coronary artery, severely narrowing it, and the left laryngeal recurrent nerve with subsequent Ortner's syndrome and brief literature review.
Compression of left main coronary artery by a dilated pulmonary artery in a female patient with atrial septal defect
2012, International Journal of Cardiology
Endovascular therapy for left main compression syndrome: Case report and literature review
2009, Chest
Citation Excerpt :
In 2001, Rich et al3 reported successful LMCA stenting in two patients with primary pulmonary hypertension and LMCA compression syndrome. Since then, several other authors4–9 have reported successful angiographic and short-term clinical outcomes with this technique (Table 1). Of note, all of the reported cases have involved compression of the ostium or proximal LMCA, sparing the left main bifurcation, and single stent placement was required.
Extrinsic compression of the left main coronary artery can occur in patients with severe pulmonary hypertension and enlarged pulmonary artery trunk. It has been usually described in the setting of congenital defects such as atrial septal defect, ventricular septal defect, and, more rarely, isolated persistent ductus arteriosus. Functional and structural evaluation of such patients can currently be performed noninvasively with the use of cardiac CT scanning and/or MRI. The optimal management of symptomatic patients remains unknown. We report a case of extrinsic compression of the LMCA in a symptomatic patient with Eisenmenger syndrome who underwent unprotected LMCA stent implantation. We also performed a literature review of the reported cases concerning patients treated with LMCA stent implantation for the management of this condition.
Acute coronary syndrome due to extrinsic compression of the left main coronary artery in a patient with severe pulmonary hypertension: successful treatment with percutaneous coronary intervention
2008, Cardiovascular Revascularization Medicine
Citation Excerpt :
Extrinsic left main compression of the LMCA by an enlarged PA should be suspected in patients with PH who present with angina. This syndrome is mainly seen in patients with idiopathic PH [2,4,6], or PH due to uncorrected (or incompletely corrected) CHD [3,7,9–11,17]. However, LMCA compression could occur in any condition that results in severe PH and significant dilation of the main pulmonary trunk.
A patient with severe pulmonary (arterial) hypertension (PH) presented with a non-ST segment elevation myocardial infarction and recurrent angina at rest. Coronary angiography showed severe ostial left main coronary artery (LMCA) stenosis; coronary arteries were otherwise normal. Intravascular ultrasonography (IVUS) showed deformation of the LMCA due to extrinsic compression from a markedly dilated main pulmonary artery, which was confirmed by cardiac computed tomography. The LMCA was successfully stented using a paclitaxel-eluting stent resulting in complete resolution of angina. Extrinsic compression of the LMCA should be considered in patients with severe PH and angina; IVUS may aid in the diagnosis. Percutaneous stent implantation may be the preferred treatment in this high-risk group of patients.
Left main coronary artery and aortic root compression associated with atrial septal defect and pulmonary hypertension
2007, International Journal of Cardiology
Citation Excerpt :
Our patient had also angina like chest pain and electrocardiographic evidence of myocardial ischemia. Some authors say that aorta-coronary artery bypass or stent implantation for the coronary artery should be the treatment for this situation [4,9], others think that the compression will decrease after the decrease of pulmonary artery pressure after the operation [2]. During the operation of our patient, pulmonary artery was freed from the aorta and plicated from its superior aspect.
The extrinsic compression of left main coronary artery (LMCA) by dilated pulmonary artery is rarely reported. Various congenital and acquired diseases were shown to cause extrinsic LMCA compression. Here we present a child with aortic root and LMCA compression due to dilated pulmonary trunk and causing angina like chest pain. The patient had also electrocardiographic evidence of myocardial ischemia. This case report will be a guide for the evaluation and surgical treatment of the patients with pulmonary hypertension and LMCA compression.
Approach to the Patient With Pulmonary Hypertension
2006, Pulmonary Vascular Disease

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El stent en la compresión del tronco coronario izquierdo en la hipertensión pulmonar primariaStenting in Primary Pulmonary Hypertension With Compression of the Left Main Coronary Artery

Chest

Chest

Am J Cardiol

J Thorac Cardiovasc Surg

An Heart J

Am Heart J

Chest

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol