Chest
Selected ReportsStenting To Reverse Left Ventricular Ischemia Due To Left Main Coronary Artery Compression in Primary Pulmonary Hypertension
Section snippets
Case 1
A 71-year-old woman was referred for management. She had a history of PPH, which had been diagnosed 12 years prior and had been treated conservatively. Although her major symptom had been dyspnea with effort, which had slowly progressed, she recently had presented with a syncopal episode and frequent chest discomfort that radiated down her right arm. The description of the chest discomfort was characteristic of angina, coming on more frequently and responsive to sublingual nitroglycerin. A
Discussion
Angina is a well-documented common symptom associated with severe pulmonary hypertension. Although the mechanism has been debated, there have been studies demonstrating right ventricular ischemia in the absence of coronary artery disease. The basis appears to be, in part, a reduction in the coronary driving pressure of the right ventricle.5 There are no studies implicating left ventricular ischemia in these patients, and because they are usually young, atherosclerotic coronary artery disease is
Conclusion
Left main coronary artery compression is a treatable cause of angina and LV ischemia in patients with PPH. We recommend that coronary angiography be performed on patients with severe pulmonary hypertension who present with effort angina or left ventricular dysfunction. As pulmonary hypertension progresses and is associated with a reduction in systemic BP, the left ventricular ischemia would predictably worsen over time and likely would be refractory to all medical treatments. In addition,
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Cited by (60)
Left main coronary artery compression in patients of atrial septal defect with dilated pulmonary artery
2021, Progress in Pediatric CardiologyCitation Excerpt :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]. In our case 1, the patient underwent surgical closure of the atrial septal defect with aortocoronary bypass.
Left Main Coronary Artery Compression in Patients With Pulmonary Arterial Hypertension
2017, Journal of the American College of CardiologyLeft 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.
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 CareCitation Excerpt :Both European and ACC/AHA Guidelines for CAD revascularization suggest Heart Time approach as a guide to decision of revascularization option.9,10 Rich et al first reported stenting of LMCA in patients with primary pulmonary hypertension in 2001, with excellent post interventional results.11 The selection of stent type depended on vessel diameter (larger left main coronary artery requires bare metal stent), as well as the possibility of sooner surgical treatment (heart and lung transplantation as the only way of definite treatment).3