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Badea R, Enache R, Predescu LM, Platon P, Catana N, Deleanu D, Iosifescu AG, Radu N, Radu T, Olaru‐Lego G, Coman IM, Popescu BA. Left main coronary artery compression in precapillary pulmonary hypertension. Pulm Circ 2024; 14:e12391. [PMID: 38784819 PMCID: PMC11112051 DOI: 10.1002/pul2.12391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 05/03/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
Pulmonary hypertension (PH) is a progressive and invalidating condition despite available therapy. Addressing complications such as left main coronary artery compression (LMCo) due to the dilated pulmonary artery (PA) may improve symptoms and survival. Nevertheless, clear recommendations are lacking. The aim of this study is to analyze the prevalence, characteristics, predictive factors and impact of LMCo in a heterogenous precapillary PH population in a single referral center. Two hundred sixty-five adults with various etiologies of precapillary PH at catheterization were reviewed. Coronary angiography (CA) was performed for LMCo suspicion. Revascularization was performed in selected cases. Outcomes were assessed at a mean follow-up of 3.9 years. LMCo was suspected in 125 patients and confirmed in 39 (31.2%), of whom 21 (16.8%) had 50%-90% stenoses. Nine revascularizations were performed, with clinical improvement. The only periprocedural complication was a stent migration. LMCo was associated with PH etiology (p 0.003), occuring more frequently in congenital heart disease-associated PH (61.5% of all LMCo cases, 66.6% of LMCo ≥ 50%). Predictors of LMCo ≥50% were PA ≥ 37.5 mm (Sn 81%, Sp 74%) and PA-to-aorta ≥1.24 (Sn 81%, Sp 69%), with increased discrimination when considering RV end-diastolic area. LMCo ≥ 50% without revascularization presented clinical deterioration and worse survival (p 0.019). This analysis of a heterogeneous pre-capillary PH population provides LMCo prevalence estimation, predictive factors (PA size, PA-to-aorta, RV end-diastolic area and PH etiology) and long-term impact. While LMCo impact on survival is inconclusive, untreated LMCo ≥ 50% has worse prognosis. LMCo revascularization may be performed safely and with good outcomes.
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Affiliation(s)
- Ruxandra Badea
- ‘Carol Davila’ University of Medicine and PharmacyBucharestRomania
| | - Roxana Enache
- ‘Carol Davila’ University of Medicine and PharmacyBucharestRomania
- Cardiology Department‘Prof. Dr. C.C. Iliescu’ Emergency Institute for Cardiovascular DiseasesBucharestRomania
| | - Lucian M. Predescu
- ‘Carol Davila’ University of Medicine and PharmacyBucharestRomania
- Cardiology Department‘Prof. Dr. C.C. Iliescu’ Emergency Institute for Cardiovascular DiseasesBucharestRomania
| | - Pavel Platon
- Cardiology Department‘Prof. Dr. C.C. Iliescu’ Emergency Institute for Cardiovascular DiseasesBucharestRomania
| | - Nicu Catana
- Cardiology Department‘Prof. Dr. C.C. Iliescu’ Emergency Institute for Cardiovascular DiseasesBucharestRomania
| | - Dan Deleanu
- Cardiology Department‘Prof. Dr. C.C. Iliescu’ Emergency Institute for Cardiovascular DiseasesBucharestRomania
| | - Andrei George Iosifescu
- ‘Carol Davila’ University of Medicine and PharmacyBucharestRomania
- Cardiology Department‘Prof. Dr. C.C. Iliescu’ Emergency Institute for Cardiovascular DiseasesBucharestRomania
| | - Noela Radu
- ‘Carol Davila’ University of Medicine and PharmacyBucharestRomania
| | - Teodora Radu
- Cardiology Department‘Prof. Dr. C.C. Iliescu’ Emergency Institute for Cardiovascular DiseasesBucharestRomania
| | - Georgiana Olaru‐Lego
- Cardiology Department‘Prof. Dr. C.C. Iliescu’ Emergency Institute for Cardiovascular DiseasesBucharestRomania
| | - Ioan M. Coman
- ‘Carol Davila’ University of Medicine and PharmacyBucharestRomania
- Cardiology Department‘Prof. Dr. C.C. Iliescu’ Emergency Institute for Cardiovascular DiseasesBucharestRomania
| | - Bogdan A. Popescu
- ‘Carol Davila’ University of Medicine and PharmacyBucharestRomania
- Cardiology Department‘Prof. Dr. C.C. Iliescu’ Emergency Institute for Cardiovascular DiseasesBucharestRomania
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Seitler S, Dimopoulos K, Ernst S, Price LC. Medical Emergencies in Pulmonary Hypertension. Semin Respir Crit Care Med 2023; 44:777-796. [PMID: 37595615 DOI: 10.1055/s-0043-1770120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
The management of acute medical emergencies in patients with pulmonary hypertension (PH) can be challenging. Patients with preexisting PH can rapidly deteriorate due to right ventricular decompensation when faced with acute physiological challenges that would usually be considered low-risk scenarios. This review considers the assessment and management of acute medical emergencies in patients with PH, encompassing both pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH), acknowledging these comprise the more severe groups of PH. Management protocols are described in a systems-based approach. Respiratory emergencies include pulmonary embolism, airways disease, and pneumonia; cardiac emergencies including arrhythmia and chest pain with acute myocardial infarction are discussed, alongside PH-specific emergencies such as pulmonary artery dissection and extrinsic coronary artery compression by a dilated proximal pulmonary artery. Other emergencies including sepsis, severe gastroenteritis with dehydration, syncope, and liver failure are also considered. We propose management recommendations for medical emergencies based on available evidence, international guidelines, and expert consensus. We aim to provide advice to the specialist alongside the generalist, and emergency doctors, nurses, and acute physicians in nonspecialist centers. A multidisciplinary team approach is essential in the management of patients with PH, and communication with local and specialist PH centers is paramount. Close hemodynamic monitoring during medical emergencies in patients with preexisting PH is vital, with early referral to critical care recommended given the frequent deterioration and high mortality in this setting.
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Affiliation(s)
- Samuel Seitler
- National Pulmonary Hypertension Service, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Konstantinos Dimopoulos
- National Pulmonary Hypertension Service, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Adult Congenital Heart Disease Service, Royal Brompton Hospital, London, United Kingdom
| | - Sabine Ernst
- Adult Congenital Heart Disease Service, Royal Brompton Hospital, London, United Kingdom
| | - Laura C Price
- National Pulmonary Hypertension Service, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Goli R, Ya’Qoub L, Blusztein D, Mahadevan VS. Treatment of left main coronary artery compression in the setting of unpalliated congenital heart disease: a case series. Eur Heart J Case Rep 2023; 7:ytad262. [PMID: 37601230 PMCID: PMC10438211 DOI: 10.1093/ehjcr/ytad262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 05/18/2023] [Accepted: 05/30/2023] [Indexed: 08/22/2023]
Abstract
Background Left main coronary artery compression syndrome (LMCS) is a well-characterized phenomenon resulting from compression of the left main coronary artery (LMCA) between the aorta and an enlarged pulmonary arterial trunk. The development of LMCS is usually described in the context of severe pulmonary arterial hypertension. Cases of LMCS, in the context of unpalliated congenital heart disease (CHD), are complex clinical scenarios that challenge traditional treatment paradigms. Case summary Here, we discuss two thought-provoking patients with unpalliated CHD complicated by severe pulmonary hypertension (PH). Both patients developed LMCS, one with severe non-ST elevation myocardial infarction and the other with refractory angina. Their pulmonary vascular resistance was severely elevated despite pulmonary vasodilator therapy, and concomitant surgical correction of their CHD in addition to bypass grafting was deemed high risk. They underwent successful percutaneous coronary intervention (PCI) of the LMCA with drug-eluting stents. Discussion Pulmonary hypertension can develop in the setting of long-standing unpalliated CHD. Surgical correction of congenital heart defects may be performed in select patients with systemic-to-pulmonary shunts, contingent on the status of PH severity. Pulmonary vasodilator therapy modulates haemodynamics to ensure surgical correction without risk of cardiopulmonary demise-termed the 'treat and repair' strategy. LMCS, an increasingly recognized phenomenon in patients with long-standing PH, is a notable complicating factor in the 'treat and repair' strategy. We introduce the concept that PCI of the LMCA may bridge patients to corrective surgery for CHD by allowing time for optimization of their pulmonary vasodilator therapy.
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Affiliation(s)
- Rahul Goli
- Division of Cardiology, Department of Medicine, University of California San Francisco, 505 Parnassus Avenue, L524, UCSF Box 0103, San Francisco, CA 94117, USA
| | - Lina Ya’Qoub
- Division of Cardiology, Department of Medicine, University of California San Francisco, 505 Parnassus Avenue, L524, UCSF Box 0103, San Francisco, CA 94117, USA
| | - David Blusztein
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Vaikom S Mahadevan
- Division of Cardiology, Department of Medicine, University of California San Francisco, 505 Parnassus Avenue, L524, UCSF Box 0103, San Francisco, CA 94117, USA
- University of Massachusetts, Chan School of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA
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Cersosimo A, Arabia G, Vizzardi E, Metra M. Rapid progression of pulmonary artery dilatation in pulmonary hypertension. Monaldi Arch Chest Dis 2022; 93. [PMID: 35872629 DOI: 10.4081/monaldi.2022.2369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/11/2022] [Indexed: 11/23/2022] Open
Abstract
We report the case of a 47-year-old woman who was admitted to the cardiac department for worsening dyspnea. The last chest computed tomography (CT) showed a rapid increase in pulmonary artery dimension (65 mm in 2019, 76 mm in 2021). The symptoms reported by the patient were due to important extrinsic compression of the left main coronary artery (LMCA). In this case, it is very difficult to choose the best therapeutic strategy. In the end, we decided to treat the left main coronary for prevention. After 3 months no new clinical symptoms have developed.
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Affiliation(s)
- Angelica Cersosimo
- Cardiology Unit, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia.
| | - Gianmarco Arabia
- Cardiology Unit, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia.
| | - Enrico Vizzardi
- Cardiology Unit, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia.
| | - Marco Metra
- Cardiology Unit, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia.
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Cabral DR, Guimarães T, Almeida AG, Campos P, Martins SR, da Silva PC, Pinto FJ, Plácido R. Chest pain in a patient with pulmonary arterial hypertension. Rev Port Cardiol 2022; 41:73-80. [DOI: 10.1016/j.repc.2020.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 03/18/2020] [Accepted: 05/05/2020] [Indexed: 10/20/2022] Open
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Left main coronary artery compression in patients of atrial septal defect with dilated pulmonary artery. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2021.101448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Labin JE, Saggar R, Yang EH, Lluri G, Sayah D, Channick R, Ardehali A, Aksoy O, Parikh RV. Left main coronary artery compression in pulmonary hypertension. Catheter Cardiovasc Interv 2020; 97:E956-E966. [PMID: 33241630 DOI: 10.1002/ccd.29401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/06/2020] [Accepted: 11/14/2020] [Indexed: 11/07/2022]
Abstract
Extrinsic compression of the left main coronary artery (LMCA) by a dilated pulmonary artery (PA) in the setting of pulmonary arterial hypertension (PAH) is an increasingly recognized disease entity. LMCA compression has been associated with angina, arrhythmia, heart failure, and sudden cardiac death in patients with PAH. Recent studies suggest that at least 6% of patients with PAH have significant LMCA compression. Screening for LMCA compression can be achieved with computed coronary tomography angiography, with a particular emphasis on assessment of PA size and any associated downward displacement and reduced takeoff angle of the LMCA. Indeed, evidence of a dilated PA (>40 mm), a reduced LMCA takeoff angle (<60°), and/or LMCA stenosis on CCTA imaging should prompt further diagnostic evaluation. Coronary angiography in conjunction with intravascular imaging has proven effective in diagnosing LMCA compression and guiding subsequent treatment. While optimal medical therapy and surgical correction remain in the clinician's arsenal, percutaneous coronary intervention has emerged as an effective treatment for LMCA compression. Given the prevalence of LMCA compression, its associated morbidity, and mortality, and the wide array of successful treatment strategies, maintaining a high degree of suspicion for this condition, and understanding the potential treatment strategies is critical.
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Affiliation(s)
- Jonathan E Labin
- Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Rajan Saggar
- Division of Pulmonary and Critical Care, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Eric H Yang
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Gentian Lluri
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - David Sayah
- Division of Pulmonary and Critical Care, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Richard Channick
- Division of Pulmonary and Critical Care, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Abbas Ardehali
- Division of Cardiothoracic Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Olcay Aksoy
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Rushi V Parikh
- Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
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Ranka S, Mohananey D, Agarwal N, Verma BR, Villablanca P, Mewhort HE, Ramakrishna H. Chronic Thromboembolic Pulmonary Hypertension-Management Strategies and Outcomes. J Cardiothorac Vasc Anesth 2019; 34:2513-2523. [PMID: 31883688 DOI: 10.1053/j.jvca.2019.11.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/14/2019] [Indexed: 11/11/2022]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is rare but complex pathophysiological disease with hallmark features of chronic thrombotic mechanical obstruction, right ventricular dysfunction, and secondary pulmonary arteriopathy. It increasingly is being understood that chronic infection/inflammation, abnormal fibrinolysis, and cytokines play an important role in pathogenesis such that only a subset of patients with pulmonary embolism develop CTEPH. Diagnosis remains challenging given the lack of early clinical signs and overlap with other cardiopulmonary conditions. Pulmonary endarterectomy is the surgical procedure of choice with good postoperative survival and functional outcomes, especially when done at high-volume centers with a multidisciplinary approach. There has been a resurgence of balloon pulmonary angioplasty (BPA) as salvage therapy for inoperable CTEPH or in its newfound hybrid role for persistent postoperative pulmonary hypertension with excellent 1-year and 3-year survival. Use of riociguat has shown promising improvements in functional outcomes up to 2 years after initiation. Endothelin receptor antagonists serve a supplemental role postoperatively or in inoperable CTEPH. The role of drug therapy preoperatively or in tandem with BPA is currently under investigation.
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Affiliation(s)
- Sagar Ranka
- Department of Cardiovascular Medicine, Kansas University Medical Center, Kansas City, KS
| | - Divyanshu Mohananey
- Department of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Nikhil Agarwal
- Division of Cardiovascular Medicine, University of Buffalo, Buffalo, NY
| | - Beni Rai Verma
- Department of Cardiology, Cleveland Clinic, Cleveland, OH
| | | | | | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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Van Tittelboom N, Devos D, Thierry B, De Pauw M, Vandecasteele E. Recurrent chest pain and dyspnoea in a patient with pulmonary arterial hypertension. Acta Clin Belg 2019; 74:292-295. [PMID: 30217123 DOI: 10.1080/17843286.2018.1516180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Pulmonary arterial hypertension (PAH) is a devastating, life-threatening disease with poor prognosis when left untreated. The long-term prognosis is definitely influenced by the natural progression of PAH but late disease-specific complications may also contribute. Case summary: We present a patient with a long-standing idiopathic PAH in whom progressive dilatation of pulmonary trunk and pulmonary arteries leads to compression of the left main coronary artery and the left atrium with hemodynamic compromise. Conclusion: With the current treatment options, survival in PAH has improved. Guidelines focus on more aggressive treatment with initial combination therapy and earlier referral for transplantation.
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Affiliation(s)
| | - Dan Devos
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Bové Thierry
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
| | - Michel De Pauw
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
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Dong X, Sun Q, Tang M, Zhang S. Types of anatomic relationship between left main coronary artery and pulmonary sinus of Valsalva: Implications for balloon pulmonary angioplasty and catheter ablation in the pulmonary root. Int J Cardiol 2019; 288:34-38. [PMID: 31029499 DOI: 10.1016/j.ijcard.2019.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/18/2019] [Accepted: 02/11/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Concerns have been raised upon the risk of left main coronary artery (LMCA) injury when balloon angioplasty or ablation is performed within the pulmonary sinus of Valsalva (PSV). OBJECTIVE To investigate the LMCA and PSV anatomic relationship (LMCA-PSVar) variants potentially susceptible to procedure complication. METHODS We retrospectively studied 100 consecutive patients undergoing computed tomography coronary angiography (CTCA). Three types of LMCA-PSVar were observed on the basis of the relative location between the LMCA ostium and left pulmonary sinus of Valsalva (LPSV): type 1, intimate contact between the LMCA ostium and LSPV; type 2, LMCA ostium opposite to LPSV and the proximal part coursing anteriorly around LSPV; and type 3, no contact between LMCA ostium and LSPV. RESULTS LMCA-PSVar types 1, 2, and 3 were present in 20(20%), 43(43%), and 37(37%) patients, respectively. For the three types of LMCA-PSVar, the minimal distance between LMCA and LPSV was 1.66 ± 0.53 mm, 4.63 ± 1.64 mm and 8.24 ± 1.65 mm, and the distance ≤5 mm were in 100%, 87% and 9% patients, respectively. Additionally, the distance from right coronary artery (RCA) to right pulmonary sinus of Valsalva (RPSV)/RVOT was ≤5 mm in 71 patients (71%). CONCLUSION The LMCA is intimately related to LPSV in majority of patients (mainly involving the types 1 and 2), whereas the RCA is often close to RPSV/RVOT. These anatomic features pose potential vulnerability to coronary injury, and should be heightened to avoid complications in this area.
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Affiliation(s)
- Xiaonan Dong
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Sun
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Tang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Shu Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Akbal OY, Kaymaz C, Tanboga IH, Hakgor A, Yilmaz F, Turkday S, Dogan C, Tanyeri S, Demir D, Bayram Z, Cicek MB, Acar RD, Ozdemir N. Extrinsic compression of left main coronary artery by aneurysmal pulmonary artery in severe pulmonary hypertension: its correlates, clinical impact, and management strategies. Eur Heart J Cardiovasc Imaging 2019; 19:1302-1308. [PMID: 29237020 DOI: 10.1093/ehjci/jex303] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 11/09/2017] [Indexed: 11/14/2022] Open
Abstract
Aims Although left main coronary artery (LMCA) compression (Co) by pulmonary artery (PA) aneurysm (A) has been reported in some pulmonary hypertension (PH) series, clinical importance and management of this complication remain to be determined. In this single-centre prospective study, we evaluated correlates, clinical impact, and management strategies of LMCA-Co in patients with PH. Methods and results Our study group comprised 269 (female 166, age 52.9 ± 17.3 years) out of 498 patients with confirmed PH who underwent coronary angiography (CA) because of the PAA on echocardiography, angina or incidentally detected LMCA-Co during diagnostic evaluation with multidetector computed tomography. The LMCA-Co ≥ 50% was documented in 22 patients (8.2%) who underwent CA, and stenosis were between 70% and 90% in 14 of these. Univariate comparisons revealed that a younger age, a D-shaped septum, a higher PA systolic, diastolic, and mean pressures and pulmonary vascular resistance, a larger PA diameter, a smaller aortic diameter and pulmonary arterial hypertension associated with patent-ductus arteriosus, atrial or ventricular septal defects were significantly associated with LMCA-Co. Bare-metal stents were implanted in 12 patients and 1 patient underwent PAA and atrial septal defect surgery and another one declined LMCA stenting procedure. Conclusion Our study demonstrates that LMCA-Co is one of the most important and potentially lethal complications of severe PH, and alertness for this risk seems to be necessary in specific circumstances related with PAA. However, long-term benefit from stenting in this setting remains as a controversy.
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Affiliation(s)
- Ozgur Yasar Akbal
- University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Denizer Street, No. 2, Cevizli / Kartal, Istanbul, Turkey
| | - Cihangir Kaymaz
- University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Denizer Street, No. 2, Cevizli / Kartal, Istanbul, Turkey
| | - Ibrahim Halil Tanboga
- Hisar Intercontinental Hospital, Department of Cardiology, Site Yolu Street, No. 7, Umraniye, Istanbul, Turkey
| | - Aykun Hakgor
- University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Denizer Street, No. 2, Cevizli / Kartal, Istanbul, Turkey
| | - Fatih Yilmaz
- University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Denizer Street, No. 2, Cevizli / Kartal, Istanbul, Turkey
| | - Sevim Turkday
- University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Denizer Street, No. 2, Cevizli / Kartal, Istanbul, Turkey
| | - Cem Dogan
- University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Denizer Street, No. 2, Cevizli / Kartal, Istanbul, Turkey
| | - Seda Tanyeri
- University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Denizer Street, No. 2, Cevizli / Kartal, Istanbul, Turkey
| | - Durmus Demir
- University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Denizer Street, No. 2, Cevizli / Kartal, Istanbul, Turkey
| | - Zubeyde Bayram
- University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Denizer Street, No. 2, Cevizli / Kartal, Istanbul, Turkey
| | - Mahmut Bugrahan Cicek
- University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Denizer Street, No. 2, Cevizli / Kartal, Istanbul, Turkey
| | - Rezzan Deniz Acar
- University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Denizer Street, No. 2, Cevizli / Kartal, Istanbul, Turkey
| | - Nihal Ozdemir
- University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Denizer Street, No. 2, Cevizli / Kartal, Istanbul, Turkey
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12
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Alfonso F, Rivero F. Left Main Coronary Artery Compression in Patients With Pulmonary Arterial Hypertension. J Am Coll Cardiol 2019; 69:2818-2820. [PMID: 28595697 DOI: 10.1016/j.jacc.2017.04.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 04/10/2017] [Accepted: 04/11/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain.
| | - Fernando Rivero
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
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13
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Worku BM, de Angelis P, Wingo ME, Leonard JR, Khan FM, Hameed I, Ruan Y, Gaudino MFL, Girardi LN. Pulmonary artery aneurysms: Preoperative, intraoperative, and postoperative findings. J Card Surg 2019; 34:570-576. [PMID: 31090116 DOI: 10.1111/jocs.14070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 04/25/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pulmonary artery aneurysms (PAAs) are a rare but potentially lethal cardiovascular pathology. PAAs tend to develop in young patients with no gender discrepancy; they are most often associated with congenital heart disorders but also with systemic infections, vasculitis, pulmonary arterial hypertension, chronic pulmonary embolism, and malignancies. Dissection and rupture carry significant morbidity and mortality, thus patients require careful management, especially those with associated pulmonary hypertension. Given the rarity of this condition, physicians have yet to establish standard treatment guidelines. Most studies published to date are case reports with one or two patients; here, we describe our experience with six cases of large PAAs treated surgically at our institution. METHODS We identified and retrospectively analyzed clinical data for patients who underwent surgery for PAAs between 2009 and 2017. RESULTS The average age at surgery was 59.73 years, five patients were females, and 83.3% had baseline hypertension. Systolic murmurs were the most common clinical finding. The average aneurysmal size was 65.0 mm. We repaired the PAA with a woven Dacron graft (22-26 mm) in four patients. We performed concomitant pulmonary valve procedures on five patients: four replacements and one repair. Mean pump and cross-clamp times were 108.5 and 65 minutes. Operative and 30-day mortality was 0%. Average length of stay was 10.5 days. CONCLUSIONS Postoperative mortality was 0%; all patients showed improvement of symptoms after surgery. These findings confirm that PAA repair has an acceptable risk profile in select patients.
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Affiliation(s)
- Berhane M Worku
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Paolo de Angelis
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Matthew E Wingo
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Jeremy R Leonard
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Faiza M Khan
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Irbaz Hameed
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Yongle Ruan
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, New York
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14
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Simakova MA, Marukyan NV, Gukov KD, Zverev DA, Moiseeva OM. Left main coronary artery compression by pulmonary artery aneurism in patients with long standing pulmonary arterial hypertension. ACTA ACUST UNITED AC 2018; 58:22-32. [PMID: 30625087 DOI: 10.18087/cardio.2580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 11/18/2022]
Abstract
This review focuses on a rare complication of pulmonary arterial hypertension (PAH), extravasation compression of the left coronary artery (LCA) dilated by the pulmonary artery. The review described clinical manifestations and methods for diagnostics of LCA compression, and advantages of the endovascular correction of this complication in patients with pulmonary hypertension. Selection of a device to be implanted during the endovascular intervention in these patients was discussed with due account for concomitant treatment with oral anticoagulants. As an illustration of the issue under discussion, a clinical case of acute coronary syndrome in a female patient from the PAH Registry of the V. A. Almazov National Medical Research Center was provided.
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15
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Miranda-Barrio B, Garcia-Romero E, Cuellar-Calabria H, Dos-Subira L. Left main coronary artery compression by a large pulmonary artery aneurysm in the absence of pulmonary hypertension: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2018; 2:yty105. [PMID: 31020181 PMCID: PMC6426109 DOI: 10.1093/ehjcr/yty105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 09/05/2018] [Indexed: 11/12/2022]
Abstract
Background Pulmonary artery aneurysms (PAAs) are rare and they are infrequently diagnosed due to the non-specificity of their symptoms. However, their related complications, mainly described in patients with pulmonary hypertension (PH), are associated with significant morbidity and mortality. Case summary We report the case of a 64-year-old woman previously operated on for pulmonary valve stenosis, who presented with rapid worsening of dyspnoea and sudden onset of chest pain. Physical examination did not show heart failure symptoms, and an echocardiogram showed significant but not severe pulmonary regurgitation with preserved right and left ventricular function. Estimated pulmonary artery (PA) pressure was normal. As myocardial ischaemia was suspected the patient underwent a coronary computed tomography angiography that showed compression of the left main coronary artery by a large PAA. Early diagnosis led to surgery that solved her symptoms. Discussion Comprehensive medical evaluation of symptomatic patients with PA dilatation, even in the absence of PH, is key to rule out the possibility of serious complications as soon as possible.
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Affiliation(s)
- Berta Miranda-Barrio
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Passeig Vall Hebron 119-129, Barcelona, Spain.,Integrated Adult Congenital Heart Disease Unit of Vall d'Hebron University Hospital and Santa Creu i Sant Pau University Hospital, Passeig Vall Hebron 119-129, Barcelona, Spain.,CIBER de las Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - Elena Garcia-Romero
- Cardiology Department, Hospital Universitari de Bellvitge, Carrer de la Feixa Llarga, s/n, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Hug Cuellar-Calabria
- Integrated Adult Congenital Heart Disease Unit of Vall d'Hebron University Hospital and Santa Creu i Sant Pau University Hospital, Passeig Vall Hebron 119-129, Barcelona, Spain.,Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig Vall Hebron 119-129, Barcelona, Spain.,IDI (Institut de Diagnòstic per la Imatge), Barcelona, Spain
| | - Laura Dos-Subira
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Passeig Vall Hebron 119-129, Barcelona, Spain.,Integrated Adult Congenital Heart Disease Unit of Vall d'Hebron University Hospital and Santa Creu i Sant Pau University Hospital, Passeig Vall Hebron 119-129, Barcelona, Spain.,CIBER de las Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
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16
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Butera G, Mansour NB, De Marco F. Emergency trans-catheter coronary intervention for left main compression secondary to pulmonary hypertension in a 4-year-old child. Catheter Cardiovasc Interv 2018; 93:105-107. [DOI: 10.1002/ccd.27796] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/25/2018] [Accepted: 06/26/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Gianfranco Butera
- Department of Congenital Cardiology and Cardiac Surgery; IRCCS Policlinico San Donato; Italy
| | - Nizar Ben Mansour
- Department of Congenital Cardiology and Cardiac Surgery; IRCCS Policlinico San Donato; Italy
| | - Federico De Marco
- Department of Congenital Cardiology and Cardiac Surgery; IRCCS Policlinico San Donato; Italy
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17
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Nashat H, Montanaro C, Li W, Kempny A, Wort SJ, Dimopoulos K, Gatzoulis MA, Babu-Narayan SV. Atrial septal defects and pulmonary arterial hypertension. J Thorac Dis 2018; 10:S2953-S2965. [PMID: 30305956 PMCID: PMC6174141 DOI: 10.21037/jtd.2018.08.92] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 08/20/2018] [Indexed: 12/19/2022]
Abstract
Atrial septal defects (ASD) are a common congenital heart defect. The majority of patient with ASDs often follow an uncomplicated course of events. However, a proportion of patients with ASDs, may have their condition complicated by pulmonary hypertension (PH), with a subsequent significant impact on management, morbidity and mortality. The presence of PH, influences the suitability for defect closure. In this review we describe the different types of ASDs, the classification of PH related to congenital heart disease (CHD), when ASD closure is contraindicated and the management of patients who develop pulmonary arterial hypertension (PAH), including the most extreme form, Eisenmenger syndrome (ES).
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Affiliation(s)
- Heba Nashat
- Department of Adult Congenital Heart Disease, Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, UK
| | - Claudia Montanaro
- Department of Adult Congenital Heart Disease, Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, UK
| | - Wei Li
- Department of Adult Congenital Heart Disease, Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, UK
| | - Aleksander Kempny
- Department of Adult Congenital Heart Disease, Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, UK
| | - Stephen J Wort
- Department of Adult Congenital Heart Disease, Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, UK
| | - Konstantinos Dimopoulos
- Department of Adult Congenital Heart Disease, Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, UK
| | - Michael A Gatzoulis
- Department of Adult Congenital Heart Disease, Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, UK
| | - Sonya V Babu-Narayan
- Department of Adult Congenital Heart Disease, Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, UK
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18
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Dong X, Tang M, Sun Q, Zhang S. Anatomical relevance of ablation to the pulmonary artery root: Clinical implications for characterizing the pulmonary sinus of Valsalva and coronary artery. J Cardiovasc Electrophysiol 2018; 29:1230-1237. [DOI: 10.1111/jce.13685] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 05/24/2018] [Accepted: 05/25/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Xiaonan Dong
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences, and Peking Union Medical College Beijing China
| | - Min Tang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences, and Peking Union Medical College Beijing China
| | - Qi Sun
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences, and Peking Union Medical College Beijing China
| | - Shu Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences, and Peking Union Medical College Beijing China
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19
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Godfrey A, Cajigas HR. A 55-Year-Old Woman With Pulmonary Hypertension, Worsening Dyspnea, and Chest Pain. Chest 2018; 145:642-645. [PMID: 27845638 DOI: 10.1378/chest.13-1735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 08/08/2013] [Indexed: 11/01/2022] Open
Affiliation(s)
- Amanda Godfrey
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI
| | - Hector R Cajigas
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI.
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20
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Price LC, Dimopoulos K, Marino P, Alonso-Gonzalez R, McCabe C, Kemnpy A, Swan L, Boutsikou M, Al Zahrani A, Coghlan GJ, Schreiber BE, Howard LS, Davies R, Toshner M, Pepke-Zaba J, Church AC, Peacock A, Corris PA, Lordan JL, Gaine S, Condliffe R, Kiely DG, Wort SJ. The CRASH report: emergency management dilemmas facing acute physicians in patients with pulmonary arterial hypertension. Thorax 2017; 72:1035-1045. [DOI: 10.1136/thoraxjnl-2016-209725] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 07/06/2017] [Accepted: 07/17/2017] [Indexed: 12/18/2022]
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21
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Abudayyeh I, Tran BG, Tobis JM. Optimizing Coronary Angioplasty with FFR and Intravascular Imaging. CURRENT CARDIOVASCULAR RISK REPORTS 2017. [DOI: 10.1007/s12170-017-0534-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Cardiac dysfunction of pulmonary artery aneurysm in patients with pulmonary arterial hypertension. Int J Cardiol 2016; 228:1035-1040. [PMID: 27931011 DOI: 10.1016/j.ijcard.2016.10.082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 10/28/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Pulmonary artery aneurysm (PAA) occurs in some patients with pulmonary arterial hypertension (PAH). We evaluated the characteristics of cardiac dysfunction in patients with PAH complicated by PAA. METHODS Echocardiography and right-heart catheterization were performed in 130 PAH patients to measure the maximum dimensions of the main pulmonary artery (MPA) trunk and evaluate right ventricular (RV) and left ventricular (LV) function. RESULTS A diameter of >40mm was defined as PAA in the MPA trunk. The maximum MPA diameter was >40mm in 32 of 130 PAH patients (24.6%: Group PAA). Systolic pulmonary artery pressure (68.0±18.5 vs. 58.9±21.6mm Hg, P=0.0354) and pulmonary capillary wedge pressure (10.8±3.9 vs. 7.7±2.6mm Hg, P<0.0001) were significantly higher in Group PAA than in Group non-PAA. RV end-diastolic area index (19.6±6.8 vs. 14.9±5.1 cm²/m², P<0.0001), and RV fractional area change (32.3±7.8 vs. 37.3±8.8%, P=0.0048) and RV longitudinal strain (-15.4±5.1 vs. -20.4±6.1, P=0.0012) were significantly lower, and E/e' was significantly higher (8.1±2.2 vs. 6.7±1.4, P=0.0002) in Group PAA than in Group non-PAA. CONCLUSIONS In PAH patients with PAA, RV was larger and RV dysfunction was more severe, and LV diastolic dysfunction appeared. It is important to investigate the appearance of PAA and the severity of RV and LV dysfunction in PAH patients with PAA.
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23
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Demerouti E, Manginas A, Petrou E, Katsilouli S, Karyofillis P, Athanassopoulos G, Karatasakis G, Iakovou I, Mihas K, Mastorakou I. Cardiac Dual-source Computed Tomography for the Detection of Left Main Compression Syndrome in Patients with Pulmonary Hyper-tension. Open Cardiovasc Med J 2016; 10:130-7. [PMID: 27499817 PMCID: PMC4951776 DOI: 10.2174/1874192401610010130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 10/20/2015] [Accepted: 11/02/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Left Main Compression Syndrome (LMCS) represents an entity described as the extrinsic compression of the left main coronary artery (LMCA) by a dilated pulmonary artery (PA) trunk. We examined the presence of LMCS in patients with pulmonary hypertension (PH) using dual-source computed tomography (DSCT), as a non-invasive diagnostic tool. METHODS The following parameters were measured: PA trunk diameter (PAD), the distance between PAD and LMCA (LMPA) and the distance between PA and aorta (AoPA). These measurements were related with demographic, echocardiographic, hemodynamic and clinical parameters. Angiography was performed in two patients with LMCS suspected by cardiac computed tomographic angiography. Patients without PH but with angina were examined as controls, using DSCT cardiac angiography to assess the same measurements and to detect the prevalence of coronary artery disease. RESULTS PA diameter value over 40.00 mm has been associated with PH and LMCS. Furthermore, LMCS did not occur at a distance smaller than 0.50 mm between the PA and the LMCA, and did not correlate with the distance between the PA and the aorta or with cardiac index and NT-proBNP. CONCLUSION DSCT may represent the initial testing modality in PH patients with dilated PA trunk to exclude LMCS. A periodical rule-out of this rare entity, as assessed by DSCT, in patients with a severely dilated PA seems to be mandatory for PH patients contributing to survival improvement.
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Affiliation(s)
| | | | - Emmanouil Petrou
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | | | | | | | | | - Ioannis Iakovou
- First Department of Interventional Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | | | - Irene Mastorakou
- Imaging Department, Onassis Cardiac Surgery Center, Athens, Greece
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24
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Pan HC, Wang KY, Liang KW. Left Main Coronary Artery Stenting to Relieve Extrinsic Compression by a Giant Pulmonary Artery Aneurysm in a Patient with Idiopathic Pulmonary Artery Hypertension. Heart Lung Circ 2016; 25:e122-5. [PMID: 27085308 DOI: 10.1016/j.hlc.2016.02.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 02/17/2016] [Indexed: 11/17/2022]
Abstract
Pulmonary artery aneurysm (PAA) is a rare but lethal disease. We present a female patient with idiopathic pulmonary artery hypertension (IPAH)-related PAA, who suffered from unstable angina pectoris. Multi-detector computed tomography and coronary angiogram revealed extrinsic compression of the left main coronary artery (LMCA) caused by a giant PAA with severe ostial stenosis. Intravascular ultrasound showed an oval-shaped ostium of the LMCA, indicating extrinsic compression. After successful LMCA stent implantation, chest pain was greatly relieved. This case illustrates that beyond right ventricle ischaemia and coronary atherosclerotic disease, LMCA compression by PAA should be considered in the differential diagnosis of angina in patients with IPAH related PAA. In addition, intravascular ultrasound can be used to confirm the diagnosis and guide the stent implantation safely.
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Affiliation(s)
- Hung-Chih Pan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kuo-Yang Wang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Medicine, Cardiovascular Research Center, School of Medicine, National Yang Ming University, Taipei, Taiwan; Department of Medicine, China Medical University, Taichung, Taiwan; Department of Medicine, Chung Shan Medical University, Taichung, Taiwan.
| | - Kae-Woei Liang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Medicine, Cardiovascular Research Center, School of Medicine, National Yang Ming University, Taipei, Taiwan.
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25
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Abstract
Pulmonary hypertension is the commonest condition leading to dilated pulmonary artery. We describe three different types of compression of adjacent anatomical structures by dilated pulmonary arteries. We included involvement of the left main coronary artery, left recurrent laryngeal nerve and tracheobronchial tree. Compression of these structures can cause major complications such as myocardial ischemia, hoarseness and major airway stenosis. We present a case for each scenario and review the literature for each of these complications, focusing on patients' characteristics and contemporary management.
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Affiliation(s)
- Wael Dakkak
- a Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute , Cleveland Clinic , Cleveland , OH , USA
| | - Adriano R Tonelli
- a Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute , Cleveland Clinic , Cleveland , OH , USA
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26
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Seabra LF, Ribeiro HB, de Barros e Silva PGM, Rodrigues MJ, Spadaro AG, Conejo F, Godinho RR, Faig SMM, de Macedo TA, de P. S. Baptista L, de Resende MVC, Furlan V, Ribeiro EE. Left Main Ostial Compression in a Patient with Pulmonary Hypertension: Dynamic Findings by IVUS. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:899-903. [PMID: 26694602 PMCID: PMC4714914 DOI: 10.12659/ajcr.895668] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 08/27/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Pulmonary artery dilatation is a common feature among patients with severe pulmonary hypertension. Left main coronary artery extrinsic compression by an enlarged pulmonary artery is a rare complication and a potential cause for chest pain and sudden cardiac death in patients with pulmonary hypertension. This situation is very rare and few reports have described it. Currently, the appropriate management of these patients remains unknown. CASE REPORT In the present report we describe the case of a 39-year-old woman who presented with a 2-year history of cardiac symptoms related to exercise. The patient underwent a 64-slice multidetector computed tomography (MDCT) coronary angiography, which showed left main coronary artery (LMCA) compression by a markedly enlarged pulmonary artery trunk (44 mm), without intraluminal stenosis or coronary artery calcium, as determined by the Agatston score. This compression was considered to be the cause of the cardiac symptoms. To confirm and plan the treatment, the patient underwent cardiac catheterization that confirmed the diagnosis of pulmonary hypertension and LMCA critical obstruction. Taking into account the paucity of information regarding the best management in these cases, the treatment decision was shared among a "heart team" that chose percutaneous coronary intervention with stent placement. An intra-vascular ultrasound was performed during the procedure, which showed a dynamic compression of the left main coronary artery. The intervention was successfully executed without any adverse events. CONCLUSIONS This case illustrates dynamic compression of the LMCA by IVUS, visually demonstrating the mechanism of the intermittent symptoms of myocardial ischemia in this kind of patient. It also shows that percutaneous stenting technique may be an appropriate treatment for this unusual situation.
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Affiliation(s)
| | - Henrique B. Ribeiro
- Department of Interventional Cardiology, Hospital Totalcor, São Paulo, SP, Brazil
| | | | | | - André G. Spadaro
- Department of Interventional Cardiology, Hospital Totalcor, São Paulo, SP, Brazil
| | - Fábio Conejo
- Department of Interventional Cardiology, Hospital Totalcor, São Paulo, SP, Brazil
| | - Roger R. Godinho
- Department of Interventional Cardiology, Hospital Totalcor, São Paulo, SP, Brazil
| | - Sandro M. M. Faig
- Department of Interventional Cardiology, Hospital Totalcor, São Paulo, SP, Brazil
| | | | | | | | | | - Expedito E. Ribeiro
- Department of Interventional Cardiology, Hospital Totalcor, São Paulo, SP, Brazil
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27
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Albadri K, Jensen JM, Christiansen EH, Mellemkjær S, Nielsen-Kudsk JE. Left main coronary artery compression in pulmonary arterial hypertension. Pulm Circ 2015; 5:734-6. [PMID: 26697183 DOI: 10.1086/683690] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
In patients with pulmonary arterial hypertension (PAH), chest pain is most likely due to right ventricular demand ischemia. We report a patient with idiopathic PAH who developed severe angina due to extrinsic compression of the left main coronary artery (LMCA) from a dilated pulmonary artery trunk. The diagnosis was verified by electrocardiogram after exercise, coronary angiography including intravascular ultrasound, and cardiac multidetector computed tomography (MDCT). The origin of the LMCA was high in the left coronary sinus, facilitating extrinsic compression. The patient was successfully treated by percutaneous coronary intervention with stent implantation in the LMCA. Extrinsic compression of the LMCA is a severe and potentially fatal complication that should be considered in all patients with PAH and angina. MDCT is the method of choice for first-line diagnosis.
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Affiliation(s)
- Kadhem Albadri
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper M Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Søren Mellemkjær
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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28
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Galiè N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, Simonneau G, Peacock A, Vonk Noordegraaf A, Beghetti M, Ghofrani A, Gomez Sanchez MA, Hansmann G, Klepetko W, Lancellotti P, Matucci M, McDonagh T, Pierard LA, Trindade PT, Zompatori M, Hoeper M. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J 2015; 46:903-75. [DOI: 10.1183/13993003.01032-2015] [Citation(s) in RCA: 1929] [Impact Index Per Article: 214.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Guidelines summarize and evaluate all available evidence on a particular issue at the time of the writing process, with the aim of assisting health professionals in selecting the best management strategies for an individual patient with a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic or therapeutic means. Guidelines and recommendations should help health professionals to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.
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29
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Galiè N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, Simonneau G, Peacock A, Vonk Noordegraaf A, Beghetti M, Ghofrani A, Gomez Sanchez MA, Hansmann G, Klepetko W, Lancellotti P, Matucci M, McDonagh T, Pierard LA, Trindade PT, Zompatori M, Hoeper M. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 2015; 37:67-119. [DOI: 10.1093/eurheartj/ehv317] [Citation(s) in RCA: 3916] [Impact Index Per Article: 435.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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30
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Ogiso M, Serizawa N, Kamishima K, Yamaguchi J, Hagiwara N. Percutaneous coronary intervention for left main compression syndrome due to severe idiopathic pulmonary arterial hypertension: one year follow-up using intravascular imaging. Intern Med 2015; 54:801-4. [PMID: 25832945 DOI: 10.2169/internalmedicine.54.3528] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 60-year-old woman presented with ST-elevation myocardial infarction due to extrinsic compression of the left main coronary artery (LMCA) caused by a dilated pulmonary artery (PA) with idiopathic pulmonary hypertension and was successfully treated with intravascular ultrasound- and optical coherence tomography-guided stenting. Continuous subcutaneous epoprostenol infusion therapy was initiated immediately after the procedure and increased aggressively. Imaging modalities were extremely useful in making the diagnosis and providing follow-up of LMCA compression syndrome in this case. Over the one-year observation period, a sufficient hemodynamic improvement was obtained, without exacerbation of the PA dilatation, resulting in the absence of compression of the LMCA.
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Affiliation(s)
- Masataka Ogiso
- Department of Cardiology, Tokyo Women's Medical University, Japan
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31
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Thoracic Manifestation of Eisenmenger’s Syndrome in Adult Patients: A MDCT Review. Lung 2014; 193:173-81. [DOI: 10.1007/s00408-014-9681-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 12/21/2014] [Indexed: 10/24/2022]
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32
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Anatomy of the left main coronary artery of particular relevance to ablation of left atrial and outflow tract arrhythmias. Heart Rhythm 2014; 11:2231-8. [DOI: 10.1016/j.hrthm.2014.08.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Indexed: 01/02/2023]
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33
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Choi YJ, Kim U, Lee JS, Park WJ, Lee SH, Park JS, Shin DG, Kim YJ. A case of extrinsic compression of the left main coronary artery secondary to pulmonary artery dilatation. J Korean Med Sci 2013; 28:1543-8. [PMID: 24133364 PMCID: PMC3792613 DOI: 10.3346/jkms.2013.28.10.1543] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 05/03/2013] [Indexed: 11/20/2022] Open
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.
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Affiliation(s)
- Yoon-Jung Choi
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Ung Kim
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Jin-Sung Lee
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Won-Jong Park
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Sang-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Jong-Seon Park
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Dong-Gu Shin
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Young-Jo Kim
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
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Chaikriangkrai K, Polsani V, Wei L, Kleiman N, Chang SM. Stenting of a left main coronary artery compressed by a dilated main pulmonary artery. Catheter Cardiovasc Interv 2013; 82:E684-7. [PMID: 23804497 DOI: 10.1002/ccd.25093] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 05/17/2013] [Accepted: 06/15/2013] [Indexed: 11/05/2022]
Abstract
Left main coronary artery (LMCA) disease caused by external compression by a dilated main pulmonary artery (MPA) is an uncommon clinical entity but is one of the reversible causes of chest pain in patients with pulmonary hypertension. Traditionally, treatment of LMCA disease involves coronary artery bypass graft surgery. However, for LMCA compression by a dilated MPA, coronary angioplasty with stenting has recently been reported to have good outcomes and might be more suitable in some patients with high risk associated with surgery. Herein, we describe a 54-year-old man with pulmonary arterial hypertension and external compression of the LMCA by the dilated main pulmonary artery that was treated with angiographic and intravascular ultrasound-guided coronary angioplasty and stenting. Also we briefly review current literatures about LMCA compression by a dilated MPA.
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Two rare conditions in an Eisenmenger patient: left main coronary artery compression and Ortner's syndrome due to pulmonary artery dilatation. Heart Lung 2013; 42:382-6. [PMID: 23831302 DOI: 10.1016/j.hrtlng.2013.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 05/28/2013] [Accepted: 06/02/2013] [Indexed: 11/23/2022]
Abstract
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.
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Albers EL, Bichell DP, Dodd DA. Left main coronary artery compression by a dilated pulmonary artery after heart transplantation in an infant with complex congenital heart disease. J Heart Lung Transplant 2013; 32:470-2. [PMID: 23375751 DOI: 10.1016/j.healun.2012.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 12/18/2012] [Accepted: 12/18/2012] [Indexed: 11/29/2022] Open
Affiliation(s)
- Erin L Albers
- Division of Pediatric Cardiology, Seattle Children’s Hospital, Seattle, Washington, USA
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Misuraca L, De Caro F, De Carlo M, Barzaghi C, Scioti G, Minzioni G, Petronio AS. Left main compression by an aortic root abscess. J Cardiovasc Med (Hagerstown) 2012; 13:207-8. [PMID: 22306781 DOI: 10.2459/jcm.0b013e3283511ec8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 79-year-old man with severe aortic stenosis, history of coronary artery disease and a recent hospitalization for sepsis presented at our institution following a syncope and angina at rest. Coronary angiography and aortography showed an aortic root abscess, causing left main coronary artery compression. This life-threatening complication of aortic valve endocarditis is rare and requires immediate surgical correction.
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Affiliation(s)
- Leonardo Misuraca
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
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Qian J, Chen Z, Zhou D, Dong L, Yang X, Ge J. Compression of left main coronary artery by a dilated pulmonary artery in a female patient with atrial septal defect. Int J Cardiol 2012; 161:e23-5. [PMID: 22483622 DOI: 10.1016/j.ijcard.2012.03.130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Accepted: 03/14/2012] [Indexed: 10/28/2022]
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Current world literature. Curr Opin Cardiol 2011; 26:356-61. [PMID: 21654380 DOI: 10.1097/hco.0b013e328348da50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Seth A. "Stressed in ……… stressed out" coronary arteries. Catheter Cardiovasc Interv 2010; 76:357-8. [PMID: 20839347 DOI: 10.1002/ccd.22751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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