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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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van der Wall EE, de Graaf FR, van Velzen JE, Jukema JW, Bax JJ, Schuijf JD. 320-row CT: does beat-to-beat motion of the coronary arteries affect image quality? Int J Cardiovasc Imaging 2011; 28:147-51. [PMID: 21279691 PMCID: PMC3275735 DOI: 10.1007/s10554-010-9794-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Accepted: 12/30/2010] [Indexed: 11/24/2022]
Affiliation(s)
- E. E. van der Wall
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
| | - F. R. de Graaf
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
| | - J. E. van Velzen
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
| | - J. W. Jukema
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
| | - J. J. Bax
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
| | - J. D. Schuijf
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
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3
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Der reanimationspflichtige Patient auf dem CT-Patiententisch. Radiologe 2011; 51:52-5. [DOI: 10.1007/s00117-010-2113-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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van der Wall EE, de Graaf FR, van Velzen JE, Jukema JW, Schuijf JD, Bax JJ. Functional analysis by 64-slice CT scanning: prediction of left ventricular dysfunction together with reduction in radiation exposure? Int J Cardiovasc Imaging 2010; 27:1089-93. [PMID: 21170591 PMCID: PMC3182322 DOI: 10.1007/s10554-010-9771-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Accepted: 12/08/2010] [Indexed: 11/24/2022]
Affiliation(s)
- E E van der Wall
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands.
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van der Wall EE, van Velzen JE, de Graaf FR, Jukema JW, Schuijf JD, Bax JJ. 320-row CT scanning: reduction in tube current parallels reduction in radiation exposure? Int J Cardiovasc Imaging 2010; 28:193-7. [PMID: 21136168 PMCID: PMC3275722 DOI: 10.1007/s10554-010-9762-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 11/26/2010] [Indexed: 11/13/2022]
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6
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100 kV versus 120 kV: effective reduction in radiation dose? Int J Cardiovasc Imaging 2010; 27:587-91. [PMID: 20809283 PMCID: PMC3101358 DOI: 10.1007/s10554-010-9693-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 08/24/2010] [Indexed: 11/13/2022]
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van der Wall EE, de Graaf FR, van Velzen JE, Jukema JW, Bax JJ, Schuijf JD. IVUS detects more coronary calcifications than MSCT; matter of both resolution and cross-sectional assessment? Int J Cardiovasc Imaging 2010; 27:1011-4. [PMID: 20623370 PMCID: PMC3182328 DOI: 10.1007/s10554-010-9668-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Accepted: 06/30/2010] [Indexed: 12/02/2022]
Affiliation(s)
- E E van der Wall
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands.
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Evidence of scar tissue: contra-indication to cardiac resynchronization therapy? Int J Cardiovasc Imaging 2010; 27:59-63. [PMID: 20614190 PMCID: PMC3035785 DOI: 10.1007/s10554-010-9664-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 06/25/2010] [Indexed: 11/06/2022]
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9
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Use of the anterior-posterior chest diameter in CT: reduction in radiation dose? Int J Cardiovasc Imaging 2010; 26:941-5. [PMID: 20526742 PMCID: PMC2991165 DOI: 10.1007/s10554-010-9647-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 05/21/2010] [Indexed: 01/07/2023]
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van der Wall EE, van Velzen JE, de Graaf FR, Boogers MM, Schuijf JD, Bax JJ. Increased accuracy in computed tomography coronary angiography; a new body surface area adapted protocol. Int J Cardiovasc Imaging 2010; 26:601-4. [PMID: 20396952 PMCID: PMC2868173 DOI: 10.1007/s10554-010-9628-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 04/02/2010] [Indexed: 11/25/2022]
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Cardiac resynchronization therapy; the importance of evaluating cardiac metabolism. Int J Cardiovasc Imaging 2010; 26:293-7. [PMID: 20148366 PMCID: PMC2846327 DOI: 10.1007/s10554-010-9597-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Accepted: 01/26/2010] [Indexed: 10/25/2022]
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Microbiologic Contamination and Time Efficiency of Use of Automatic MDCT Injectors With Prefilled Syringes: Results of a Clinical Investigation. AJR Am J Roentgenol 2010; 194:299-303. [DOI: 10.2214/ajr.09.3189] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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van der Wall EE, Schalij MJ, Bax JJ. Cardiac resynchronization therapy; evaluation by advanced imaging techniques. Int J Cardiovasc Imaging 2009; 26:199-202. [PMID: 20039137 PMCID: PMC2817077 DOI: 10.1007/s10554-009-9560-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 12/14/2009] [Indexed: 11/30/2022]
Affiliation(s)
- E. E. van der Wall
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
| | - M. J. Schalij
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
| | - J. J. Bax
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
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van der Wall EE, Schuijf JD, Bax JJ, Jukema JW, Schalij MJ. CT perfusion angiography; beware of artifacts! Int J Cardiovasc Imaging 2009; 26:355-8. [PMID: 20033784 PMCID: PMC2846328 DOI: 10.1007/s10554-009-9559-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 12/04/2009] [Indexed: 12/21/2022]
Affiliation(s)
- E. E. van der Wall
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
| | - J. D. Schuijf
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
| | - J. J. Bax
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
| | - J. W. Jukema
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
| | - M. J. Schalij
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
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van der Wall EE, Schuijf JD, Bax JJ, Jukema JW, Schalij MJ. Fingertip digital thermal monitoring: a fingerprint for cardiovascular disease? Int J Cardiovasc Imaging 2009; 26:249-52. [PMID: 20012695 PMCID: PMC2817076 DOI: 10.1007/s10554-009-9552-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Accepted: 11/30/2009] [Indexed: 12/31/2022]
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van der Wall EE, Schuijf JD, Bax JJ. Low-dose CT angiography: sufficient contrast for vessel imaging? Int J Cardiovasc Imaging 2009; 25:631-3. [PMID: 19444641 PMCID: PMC2712064 DOI: 10.1007/s10554-009-9467-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 04/14/2009] [Indexed: 11/30/2022]
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CT angiography; useful in non-selected outpatients? Int J Cardiovasc Imaging 2009; 25:315-8. [DOI: 10.1007/s10554-008-9421-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Accepted: 12/24/2008] [Indexed: 10/21/2022]
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de Jesus Perez VA, Haddad F, Vagelos RH, Fearon W, Feinstein J, Zamanian RT. Angina associated with left main coronary artery compression in pulmonary hypertension. J Heart Lung Transplant 2009; 28:527-30. [PMID: 19416787 DOI: 10.1016/j.healun.2008.12.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 11/15/2008] [Accepted: 12/01/2008] [Indexed: 10/21/2022] Open
Abstract
Chest pain is a common complaint in patients with pulmonary arterial hypertension (PAH). Left main coronary artery (LMCA) compression by an enlarged pulmonary artery trunk (PAT) has been associated with angina, but appropriate diagnostic and treatment approaches remain poorly defined. We present two cases of angina caused by LMCA compression from an enlarged pulmonary artery, one of which also presented with new, severe left ventricular systolic dysfunction attributed to myocardial ischemia. Diagnosis of LMCA stenosis was made via coronary angiography followed by computed tomography-gated coronary angiography (CT-CA), which confirmed pulmonary artery enlargement as the source of extrinsic compression. Restoring LMCA patency with percutaneous intervention and/or aggressive treatment of pulmonary hypertension led to significant improvement in angina, cardiac function and quality of life. Given the negative impact on cardiac function, prompt diagnosis and treatment of extrinsic LMCA compression should be considered a priority.
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Affiliation(s)
- Vinicio A de Jesus Perez
- Division of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
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van der Wall EE, Schuijf JD, Jukema JW, Bax JJ, Schalij MJ. Non-significant left main disease; truly non-significant? Int J Cardiovasc Imaging 2009; 25:439-42. [PMID: 19221891 DOI: 10.1007/s10554-009-9436-3] [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] [Received: 01/29/2009] [Accepted: 01/30/2009] [Indexed: 11/25/2022]
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Atherosclerotic plaque imaging by PET/CT; can inactive, active and mixed plaques be discerned? Int J Cardiovasc Imaging 2008; 25:141-4. [DOI: 10.1007/s10554-008-9395-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2008] [Accepted: 11/16/2008] [Indexed: 10/21/2022]
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22
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Dual source computed tomography: automated, visual or dual analysis? Int J Cardiovasc Imaging 2008; 25:205-8. [PMID: 19037747 DOI: 10.1007/s10554-008-9391-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2008] [Accepted: 11/09/2008] [Indexed: 10/21/2022]
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Monitoring plaque composition: is it worthwile? Int J Cardiovasc Imaging 2008; 25:259-61. [PMID: 19037748 DOI: 10.1007/s10554-008-9390-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Accepted: 10/31/2008] [Indexed: 10/21/2022]
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24
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Aortic and coronary atherosclerosis: a natural association? Int J Cardiovasc Imaging 2008; 25:219-22. [DOI: 10.1007/s10554-008-9389-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Accepted: 11/06/2008] [Indexed: 10/21/2022]
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Triple rule-out CT coronary angiography: three of a kind? Int J Cardiovasc Imaging 2008; 25:327-30. [PMID: 19002601 DOI: 10.1007/s10554-008-9381-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Accepted: 10/20/2008] [Indexed: 10/21/2022]
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Kalra S, Duggal S, Valdez G, Smalligan RD. Review of acute coronary syndrome diagnosis and management. Postgrad Med 2008; 120:18-27. [PMID: 18467805 DOI: 10.3810/pgm.2008.04.1756] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Acute coronary syndrome (ACS) refers to a group of clinical conditions caused by myocardial ischemia including unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). Appropriate and accurate diagnosis has life-saving implications and requires a quick but thorough evaluation of the patient's history, physical examination, electrocardiogram, radiographic studies, and cardiac biomarkers. The management of patients with suspected or confirmed ACS continues to evolve as new evidence from clinical trials is considered and as new technology becomes available to both primary care physicians and cardiologists. Low- and intermediate-risk patients have frequently been managed in a chest pain center or in the emergency department. While stress testing with or without radionuclide imaging is the most common evaluation method, a CT angiogram is sometimes substituted. High-risk patients are often managed with an early invasive strategy involving left heart catheterization with a goal of prompt revascularization of at-risk, viable myocardium. With the increased availability of cardiac catheterization facilities, patients with STEMI are more commonly being managed with primary percutaneous coronary intervention, although thrombolysis is still used where such facilities are not immediately available. This article provides primary care physicians with a concise review of the pathophysiology, clinical evaluation, and management of ACS based on the best available evidence in 2008.
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Affiliation(s)
- Sumit Kalra
- Department of Internal Medicine, Box 70622, East Tennessee State University, Johnson City, TN 37604, USA.
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Beyar R. Biomarkers, imaging and interventions--going up hill. ACUTE CARDIAC CARE 2007; 9:195-196. [PMID: 18030625 DOI: 10.1080/17482940701760298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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