Dynamic compression of the left main coronary artery by the left atrium

We report a case of a 67-year-old woman with a past medical history of severe mitral valve regurgitation with worsening congestive heart failure symptoms and angina. Coronary angiography revealed dynamic limitation of contrast flow during systole in the left main (LM) coronary artery, but no evidence of obstructive atherosclerotic disease. Intravascular ultrasound demonstrated a dynamic distortion and reduction of the LM coronary artery cross sectional area during systole. Cardiac computed tomography demonstrated left atrial enlargement with extrinsic distortion and compression of the LM coronary artery. A diagnosis was made of dynamic compression of the LM coronary artery secondary to systolic left atrial enlargement resulting from mitral regurgitation.

Endovascular therapy for left main compression syndrome. Case report and literature review

Extrinsic compression of the left main coronary artery (LMCA) can occur in patients with severe pulmonary hypertension and enlarged pulmonary artery trunk. It has been usually described in the setting of congenital defects such as atrial septal defect, ventricular septal defect, and, more rarely, isolated persistent ductus arteriosus. Functional and structural evaluation of such patients can currently be performed noninvasively with the use of cardiac CT scanning and/or MRI. The optimal management of symptomatic patients remains unknown. We report a case of extrinsic compression of the LMCA in a symptomatic patient with Eisenmenger syndrome who underwent unprotected LMCA stent implantation. We also performed a literature review of the reported cases concerning patients treated with LMCA stent implantation for the management of this condition.