J Korean Med Sci.  2013 Oct;28(10):1543-1548. 10.3346/jkms.2013.28.10.1543.

A Case of Extrinsic Compression of the Left Main Coronary Artery Secondary to Pulmonary Artery Dilatation

• Choi YJ
• Kim U
• Lee JS
• Park WJ
• Lee SH
• Park JS
• Shin DG
• Kim YJ

• KMID: 1777696
• DOI: http://doi.org/10.3346/jkms.2013.28.10.1543

Abstract

Extrinsic compression of the left main coronary artery (LMCA) secondary to pulmonary artery dilatation is a rare syndrome. Most cases of pulmonary artery hypertension but no atherosclerotic risk factors rarely undergo coronary angiography, and hence, diagnoses are seldom made and proper management is often delayed in these patients. We describe a patient that presented with pulmonary hypertension, clinical angina, and extrinsic compression of the LMCA by the pulmonary artery, who was treated successfully by percutaneous coronary intervention. Follow-up coronary angiography showed patent stent in the LMCA in the proximity of the dilated main pulmonary artery. This case reminds us that coronary angiography and percutaneous coronary intervention should be considered in pulmonary hypertension patients presenting with angina or left ventricular dysfunction.

Keyword

Pulmonary Artery Dilatation; Coronary Arteries; Percutaneous Coronary Intervention

MeSH Terms

Angina Pectoris/etiology
Angioplasty, Balloon, Coronary
Coronary Angiography
Coronary Stenosis/radiography/therapy
Coronary Vessels/radiography/*ultrasonography
Dilatation, Pathologic
Female
Humans
Hypertension, Pulmonary/etiology/radiography
Middle Aged
Pulmonary Artery/radiography/*ultrasonography
Stents
Tomography, X-Ray Computed
Ventricular Dysfunction, Left

Figure

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  Fig. 1 Chest X-ray. Cardiomegaly involving right chambers, enlarged pulmonary trunk (arrow), and right main pulmonary artery (head arrow).

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  Fig. 2 Chest CT scan with contrast. (A) Markedly dilated pulmonary trunk (68mm) and pulmonary arteries. (B) Dilated main pulmonary artery trunk pressing against left main coronary artery. Arrows point to compression. AO, aorta; PA, main pulmonary artery trunk; LV, Left ventricle.

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  Fig. 3 Transthoracic echocardiogram shows evidence of a dilated main pulmonary artery trunk pressing against left main coronary artery.

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  Fig. 4 Coronary angiography. (A) Right coronary angiography demonstrated minimal stenosis with grade 2 collaterals to the left circumflex artery and an arteriovenous fistula connecting with pulmonary artery. (B) Left coronary angiography demonstrated hypoplasia of left coronary artery and only diagonal branch was observed without left anterior descending (LAD) and left circumflex coronary artery (LCX). The study also reveals narrowing of the LMCA at its take-off from the aorta (arrow). (C) After balloon angioplasty, LAD and LCX was observed with LMCA dissection (arrow). (D) After stenting of the left main stenosis, excellent results with wide lumen of the left main coronary artery.

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  Fig. 5 ECG-gated, 128-slice multidetector computed tomography (MDCT) coronary angiography demonstrated extrinsic compression of the LMCA by dilated pulmonary arterial trunk (arrow).

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  Fig. 6 One year after stenting follow-up. Coronary angiography (A) and a computed tomography with contrast (B) showed a widely patent stent in the LMCA in proximity of the dilated main pulmonary artery.

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