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Ezeh E, Perdoncin M, Suliman M, Akhigbe EJ, Sayyed R. Dehiscent Prosthetic Aortic Valve and Aortic Root Pseudoaneurysm Complicated by Left Main Coronary Artery Compression. Cureus 2023; 15:e35096. [PMID: 36945259 PMCID: PMC10024821 DOI: 10.7759/cureus.35096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 02/19/2023] Open
Abstract
Prosthetic aortic valve dehiscence is an uncommon complication of prosthetic valve endocarditis that may occur in patients who have undergone aortic valve replacement (AVR). The concurrent presence of aortic root pseudoaneurysm may further complicate the clinical presentation through the external compression of coronary arteries. Thus, patients may present with clinical features of coronary ischemia. Echocardiogram and coronary angiography are useful in establishing diagnosis. Treatment involves a multidisciplinary approach involving cardiologists, infectious disease specialists, and cardiothoracic surgeons. The authors of this study discuss a 51-year-old male who presented with anginal chest pain and was found to have a new left bundle branch block, elevated troponins, and left main coronary artery compression complicating aortic root aneurysm. He ended up requiring a re-do AVR, repair of the pseudoaneurysm, and coronary artery bypass graft.
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Affiliation(s)
- Ebubechukwu Ezeh
- Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Maddie Perdoncin
- Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Mohamed Suliman
- Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Esiemoghie J Akhigbe
- Internal Medicine-Pediatrics, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Rameez Sayyed
- Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
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Chida-Nagai A, Tsujino I, Yakuwa S, Akagawa H, Tsujioka T, Taniguchi K, Sasaki O, Izumi G, Yamazawa H, Takeda A. A Cardiac Arrest Case due to Left Coronary Artery Compression in Congenital Heart Disease-Associated Pulmonary Arterial Hypertension. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2022; 1:229-231. [PMID: 37969429 PMCID: PMC10642145 DOI: 10.1016/j.cjcpc.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/13/2022] [Indexed: 11/17/2023]
Abstract
We report the case of an adult who had a cardiac arrest in the setting of pulmonary hypertension and a previously repaired intermediate atrioventricular septal defect, with left main coronary trunk stenosis due to dilatation of the main pulmonary artery. In patients with pulmonary hypertension exhibiting anginal symptoms, it is advisable to perform chest contrast computed tomography to confirm the pulmonary artery diameter and the presence of coronary artery compression. In addition, our case highlights the importance of early collaboration among specialists during the transition from adolescence to adulthood.
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Affiliation(s)
- Ayako Chida-Nagai
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Ichizo Tsujino
- Department of Respiratory, Hokkaido University Hospital, Sapporo, Japan
| | - Satoshi Yakuwa
- Department of Pediatrics, Obihiro Kosei Hospital, Obihiro, Japan
| | - Hiroyuki Akagawa
- Tokyo Women’s Medical University Institute of Integrated Medical Sciences, Tokyo, Japan
| | - Takao Tsujioka
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Kota Taniguchi
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Osamu Sasaki
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Gaku Izumi
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Hirokuni Yamazawa
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Atsuhito Takeda
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
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3
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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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Arain FD, Gilbride VA. Pulmonary Artery Aneurysm Associated With Severe Pulmonary Hypertension in a Patient Presenting for Double Lung Transplant: Review of a Rare Disorder and Role of Transesophageal Echocardiography. Semin Cardiothorac Vasc Anesth 2021; 25:164-172. [DOI: 10.1177/10892532211007259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pulmonary artery aneurysm (PAA) is a rare disorder that may be classified as congenital, acquired, or idiopathic, in the case of unclear etiology. When associated with severe idiopathic pulmonary arterial hypertension, such a case of PAA may present to the operating room as an indication for lung transplantation. In this article, we present such a case of a patient with a giant main and right PAA that underwent a double lung transplant. We describe the pathophysiology and natural course of this PAA and discuss the role of intraoperative transesophageal echocardiography in the management of patients with this rare diagnosis.
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Affiliation(s)
- Faisal D. Arain
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Acute Myocardial Infarction due to External Compression of the Left Main Coronary Artery by a Large Pulmonary Artery Aneurysm. Case Rep Cardiol 2021; 2021:8850044. [PMID: 33680519 PMCID: PMC7925067 DOI: 10.1155/2021/8850044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/23/2020] [Accepted: 01/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background Although rare, external compression of the left main coronary artery (LMCA) by a pulmonary arterial aneurysm (PAA) as a consequence of pulmonary arterial hypertension causing stable angina pectoris is well described. However, acute myocardial infarction is extremely rare, particularly with a full array of electrocardiographic, biochemical, and echocardiographic features, as in this scenario. Case In this case, a 62-year-old man with a past history of severe fibrotic lung disease was hospitalised with chest pain. The patient had dynamic anterolateral ischaemic changes on electrocardiography and serially elevated high-sensitivity troponin I. Transthoracic echocardiography revealed impaired left ventricular ejection fraction with anterolateral hypokinesis. Coronary angiography with intracoronary imaging revealed external compression of the LMCA. Computer tomography (CT) scans confirmed new PAA, compared to previous scans. The patient was successfully treated by percutaneous coronary stent implantation. Conclusion Progressive dilatation of the pulmonary artery due to pulmonary arterial hypertension can result in acute MI secondary to external compression of the LMCA. Clinicians should be mindful of acute coronary syndromes in patients with long-standing pulmonary hypertension presenting with chest pain.
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Lee SE, Im JH, Sung JM, Cho IJ, Shim CY, Hong GR, Chung N, Jung JW, Chang HJ. Detection of mechanical complications related to the potential risk of sudden cardiac death in patients with pulmonary arterial hypertension by computed tomography. Int J Cardiol 2017; 243:460-465. [DOI: 10.1016/j.ijcard.2017.05.090] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 05/12/2017] [Accepted: 05/22/2017] [Indexed: 11/25/2022]
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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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Nesta M, Cammertoni F, Mangini S, Colizzi C, Bruno P, Massetti M. Angina in left main coronary artery occlusion by pulmonary artery aneurysm. Asian Cardiovasc Thorac Ann 2016; 25:216-218. [DOI: 10.1177/0218492315603212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 51-year-old woman with exercise angina and a history of pulmonary artery hypertension related to a previous pulmonary thromboembolism, was referred to our hospital. Computed tomography and coronary angiography showed a 95-mm aneurysm of the main pulmonary artery, which totally occluded the left main coronary artery. After a multidisciplinary evaluation, we recommended heart-lung transplantation, but the patient refused any kind of surgical procedure. Due to the chronic occlusion, stenting of the left main coronary artery was unfeasible. With no other options available, we could only start pulmonary antihypertensive therapy. At the 1-year follow-up, the patient reported relief of her angina.
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Affiliation(s)
- Marialisa Nesta
- Department of Cardiovascular Medicine, Division of Cardiac Surgery, Catholic University Hospital, Rome, Italy
| | - Federico Cammertoni
- Department of Cardiovascular Medicine, Division of Cardiac Surgery, Catholic University Hospital, Rome, Italy
| | - Stefano Mangini
- Department of Cardiovascular Medicine, Division of Cardiac Surgery, Catholic University Hospital, Rome, Italy
| | - Christian Colizzi
- Department of Cardiovascular Medicine, Division of Cardiac Surgery, Catholic University Hospital, Rome, Italy
| | - Piergiorgio Bruno
- Department of Cardiovascular Medicine, Division of Cardiac Surgery, Catholic University Hospital, Rome, Italy
| | - Massimo Massetti
- Department of Cardiovascular Medicine, Division of Cardiac Surgery, Catholic University Hospital, Rome, Italy
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Lee SE, An HY, Im JH, Sung JM, Cho IJ, Shim CY, Hong GR, Chung N, Jung JW, Chang HJ. Screening of Mechanical Complications of Dilated Pulmonary Artery Related to the Risk for Sudden Cardiac Death in Patients with Pulmonary Arterial Hypertension by Transthoracic Echocardiography. J Am Soc Echocardiogr 2016; 29:561-6. [DOI: 10.1016/j.echo.2016.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Indexed: 12/31/2022]
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10
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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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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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Anzouan-Kacou JB, Séka R, N'guetta R, Kramoh E, Konin C. [Giant pulmonary artery aneurysm: etiology and an exceptional 17 years natural course]. Ann Cardiol Angeiol (Paris) 2014; 64:116-20. [PMID: 24841424 DOI: 10.1016/j.ancard.2014.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 04/08/2014] [Indexed: 11/27/2022]
Abstract
True pulmonary artery aneurysm (AAP) is rare and represent less than 1% of intra-thoracic aneurysms. We report a case of a AAP in a patient with a likely cor triatrium sinister, with an obstructive membrane responsible for pulmonary hypertension, explaining AAP. The long-term evolution of 17 years is made to an uncomplicated myocardial infarction. The patient died eight months later suddenly probably due to the rupture of the PAA.
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Affiliation(s)
- J-B Anzouan-Kacou
- Service des explorations externes, institut de cardiologie d'Abidjan, BP V 206, Abidjan, Côte d'Ivoire.
| | - R Séka
- Service des explorations externes, institut de cardiologie d'Abidjan, BP V 206, Abidjan, Côte d'Ivoire
| | - R N'guetta
- Service des explorations externes, institut de cardiologie d'Abidjan, BP V 206, Abidjan, Côte d'Ivoire
| | - E Kramoh
- Service des explorations externes, institut de cardiologie d'Abidjan, BP V 206, Abidjan, Côte d'Ivoire
| | - C Konin
- Service des explorations externes, institut de cardiologie d'Abidjan, BP V 206, Abidjan, Côte d'Ivoire
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Ergenoglu MU, Yerebakan H, Demirsoy E. Extrinsic Compression of the Left Main Coronary Artery: A Case of Atrial Septal Defect with Enlarged Pulmonary Artery. Heart Surg Forum 2012; 15:E158-60. [DOI: 10.1532/hsf98.20111144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report the case of an adult referred to our center with an initial diagnosis of stenosis of the left main coronary artery (LMCA). A preoperative investigation disclosed an atrial septal defect (ASD) with pulmonary artery hypertension. The angiographic studies confirmed the diagnosis and showed external compression of the LMCA by an enlarged pulmonary artery. Surgical closure of the ASD and tricuspid valve ring annuloplasty with coronary artery bypass surgery (left internal mammary artery to left anterior descending artery) were undertaken. Six months after the surgery, the patient is doing well.
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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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Koppara T, Mehilli J, Hager A, Kaemmerer H. Left main coronary artery compression in a young woman with Eisenmenger syndrome. HEART ASIA 2011; 3:13-5. [PMID: 27325973 DOI: 10.1136/ha.2009.001578] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lee MS, Oyama J, Bhatia R, Kim YH, Park SJ. Left main coronary artery compression from pulmonary artery enlargement due to pulmonary hypertension: A contemporary review and argument for percutaneous revascularization. Catheter Cardiovasc Interv 2010; 76:543-50. [DOI: 10.1002/ccd.22592] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Affiliation(s)
- Elan Hekier
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego School of Medicine, La Jolla, CA.
| | - Jess Mandel
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego School of Medicine, La Jolla, CA
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Abstract
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.
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20
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Aortic pseudoaneurysm compressing the left coronary artery. J Thorac Cardiovasc Surg 2009; 138:236-7. [PMID: 19577088 DOI: 10.1016/j.jtcvs.2008.02.077] [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: 02/05/2008] [Accepted: 02/14/2008] [Indexed: 11/23/2022]
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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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Lindsey JB, Brilakis ES, Banerjee S. Acute coronary syndrome due to extrinsic compression of the left main coronary artery in a patient with severe pulmonary hypertension: successful treatment with percutaneous coronary intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2008; 9:47-51. [DOI: 10.1016/j.carrev.2007.07.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Accepted: 07/11/2007] [Indexed: 10/22/2022]
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Abstract
Accurate diagnosis of pulmonary arterial hypertension is a challenging and complex process that requires a high index of clinical suspicion from even the most astute clinician. This article discusses the use of a variety of noninvasive tests that can help define the population of patients in whom invasive cardiac catheterization should be pursued. It points out the vagaries and limitations of electrocardiography and the radiographic and echocardiographic clues to the diagnosis. Ultimately, right- and, often, concomitant left-heart catheterization is required to establish the diagnosis and distinguish pulmonary arterial hypertension from pulmonary venous hypertension.
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Affiliation(s)
- Terence K Trow
- Section of Pulmonary and Critical Care Medicine, Division of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, P.O. Box 208057, New Haven, CT 06520-8057, USA.
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Painful Disorders of the Respiratory System. Pain Manag 2007. [DOI: 10.1016/b978-0-7216-0334-6.50079-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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25
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Yang M, Lee DJ, Jeong IS. Left Main Stem Bronchus Compression Occurred in Primary Pulmonary Hypertension Patient - A case report -. Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.53.1.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Mikyung Yang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dae Jin Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ik Soo Jeong
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, Gregoratos G, Klein G, Moss AJ, Myerburg RJ, Priori SG, Quinones MA, Roden DM, Silka MJ, Tracy C, Smith SC, Jacobs AK, Adams CD, Antman EM, Anderson JL, Hunt SA, Halperin JL, Nishimura R, Ornato JP, Page RL, Riegel B, Priori SG, Blanc JJ, Budaj A, Camm AJ, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). J Am Coll Cardiol 2006; 48:e247-346. [PMID: 16949478 DOI: 10.1016/j.jacc.2006.07.010] [Citation(s) in RCA: 863] [Impact Index Per Article: 47.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, Gregoratos G, Klein G, Moss AJ, Myerburg RJ, Priori SG, Quinones MA, Roden DM, Silka MJ, Tracy C, Smith SC, Jacobs AK, Adams CD, Antman EM, Anderson JL, Hunt SA, Halperin JL, Nishimura R, Ornato JP, Page RL, Riegel B, Blanc JJ, Budaj A, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 2006; 114:e385-484. [PMID: 16935995 DOI: 10.1161/circulationaha.106.178233] [Citation(s) in RCA: 807] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Peters CW, Layon AJ. Postoperative asystole in a vasculopathic man. J Clin Anesth 2006; 18:230-6. [PMID: 16731330 DOI: 10.1016/j.jclinane.2005.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2005] [Accepted: 06/02/2005] [Indexed: 11/24/2022]
Abstract
We present a case of postoperative cardiac arrest caused by extrinsic occlusion of the right coronary artery by an aortic pseudoaneurysm. Extrinsic impingement upon the coronary arteries may result from several etiologies and lead to cardiac symptoms identical to those caused by intrinsic coronary disease. Extrinsic compression may be amenable to treatment with angioplasty or a combination of angioplasty and surgery.
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Affiliation(s)
- Carl W Peters
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, 32610-0254, USA
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Caplan-Shaw CE, Kawut SM, Sonett JR, Pearson GD, Rozenshtein A, Apfelbaum MA, Arcasoy SM, Wilt JS. LEFT MAIN CORONARY ARTERY COMPRESSION BY AN ENLARGED PULMONARY ARTERY IN PULMONARY HYPERTENSION DUE TO DIFFUSE PARENCHYMAL LUNG DISEASE AND SUCCESSFUL TREATMENT BY LUNG TRANSPLANTATION. Chest 2005. [DOI: 10.1378/chest.128.4_meetingabstracts.435s] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Decuypere V, Delcroix M, Budts W. Left main coronary artery and right pulmonary vein compression by a large pulmonary artery aneurysm. BRITISH HEART JOURNAL 2004; 90:e21. [PMID: 15020539 PMCID: PMC1768180 DOI: 10.1136/hrt.2003.029694] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Pulmonary artery aneurysms are uncommon and may be associated with significant morbidity and mortality. The unique combination of left main coronary artery and upper right pulmonary vein compression by a large pulmonary artery aneurysm is reported. Furthermore, the aetiology, clinical manifestations, complications, diagnostic approach, and possible therapeutic interventions are briefly discussed.
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Affiliation(s)
- V Decuypere
- Department of Cardiology, University Hospitals, Leuven, Belgium
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31
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Mesquita SMF, Castro CRP, Ikari NM, Oliveira SA, Lopes AA. Likelihood of left main coronary artery compression based on pulmonary trunk diameter in patients with pulmonary hypertension. Am J Med 2004; 116:369-74. [PMID: 15006585 DOI: 10.1016/j.amjmed.2003.11.015] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2003] [Revised: 11/06/2003] [Accepted: 11/06/2003] [Indexed: 10/26/2022]
Abstract
PURPOSE In patients with pulmonary hypertension, extrinsic compression of the left main coronary artery by a dilated pulmonary trunk may cause angina, left ventricular ischemia, and sudden death. We assessed coronary artery compression in relation to pulmonary trunk diameter and other demographic, echocardiographic, hemodynamic, and scintigraphic variables. METHODS Thirty-six patients (aged 15 to 86 years) with pulmonary hypertension, either idiopathic or associated with congenital heart disease, were enrolled. Left main coronary artery compression was defined angiographically as > or =50% obstruction associated with downward displacement of the vessel. Pulmonary trunk and aortic diameters were measured by transthoracic echocardiography. RESULTS Twenty-six patients had angina, of whom 7 had left coronary artery compression. Compression was related to pulmonary trunk diameter (P = 0.002) and to the ratio of pulmonary trunk diameter to aortic diameter (P = 0.02). Compression was not seen at pulmonary artery diameters <40 mm; among 19 patients with values > or =40 mm, the rate was 37%. Similarly, compression did not occur at pulmonary trunk to aortic diameter ratios <1.21; among 27 patients with ratios > or =1.21, the rate was 26%. CONCLUSION In pulmonary hypertension, noninvasive measurement of pulmonary trunk diameter may be helpful in determining the likelihood of left coronary artery compression and in selecting patients for diagnostic coronary angiography.
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Affiliation(s)
- Sonia M F Mesquita
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
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Gómez Varela S, Montes Orbe PM, Alcíbar Villa J, Egurbide MV, Sainz I, Barrenetxea Benguría JI. El stent en la compresión del tronco coronario izquierdo en la hipertensión pulmonar primaria. Rev Esp Cardiol 2004. [DOI: 10.1016/s0300-8932(04)77171-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Rich S, McLaughlin VV, O'Neill W. Stenting to reverse left ventricular ischemia due to left main coronary artery compression in primary pulmonary hypertension. Chest 2001; 120:1412-5. [PMID: 11591592 DOI: 10.1378/chest.120.4.1412] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Angina is a common symptom of severe pulmonary hypertension. Although many theories for the source of this pain have been proposed, right ventricular ischemia is the one most commonly accepted as the cause. We report on two patients with primary pulmonary hypertension who had angina with normal activity or on provocation. One patient had severe left ventricular dysfunction. Both were found to have severe ostial stenosis of the left main coronary artery as a result of compression from a dilated pulmonary artery. Both patients underwent stenting of the left main coronary artery with excellent angiographic results, and complete resolution of the signs and symptoms of angina and left ventricular ischemia. Left ventricular ischemia due to compression of the left main coronary artery may be a much more common mechanism of angina and left ventricular dysfunction in patients with pulmonary hypertension than previously acknowledged. Stenting of the coronary artery can be done safely with the resolution of these symptoms.
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Affiliation(s)
- S Rich
- Section of Cardiology, Rush Medical College, Chicago, IL 60612-3824, USA
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35
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Kajita LJ, Martinez EE, Ambrose JA, Lemos PA, Esteves A, Nogueira da Gama M, Jatene AD, Ramires JA. Extrinsic compression of the left main coronary artery by a dilated pulmonary artery: clinical, angiographic, and hemodynamic determinants. Catheter Cardiovasc Interv 2001; 52:49-54. [PMID: 11146522 DOI: 10.1002/1522-726x(200101)52:1<49::aid-ccd1012>3.0.co;2-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Extrinsic compression of the left main coronary artery (LMC) by the pulmonary artery (PA) is a very unusual and poorly understood entity, usually associated with the presence of adult congenital heart disease. We identified 12 patients (age range, 6 months to 55 years) with LMC stenosis (> or = 50%) presumably secondary to compression by a dilated main PA and related to various forms of heart disease (11 congenital, 1 pulmonary hypertension). In all cases, the main PA was dilated with the main PA/aortic root diameter increased (mean, 2.0; normal value, < or = 1.0), and in all but two, PA pressures were increased (> 30 mm Hg systolic). Left coronary trunk stenosis was usually visualized in only one angiographic view (best seen in 45 degrees left anterior oblique, 30 degrees cranial projection). The LMC also appeared to be inferiorly displaced and in close contact with the left aortic sinus (mean angle between sinus and LMC was 23 degrees +/- 13 degrees, a control group was 70 degrees +/- 15 degrees ). In one patient, surgical correction of the dilated PA was associated with a reduction in LMC stenosis from 85% to < 50% and less inferior left main displacement (from 25 degrees to 50 degrees ). Patients with a dilated main PA may exhibit extrinsic LMC compression leading to significant eccentric narrowing and downward displacement of the LMC. In the presence of significant dilatation of the main PA from any etiology, functional and/or anatomic studies should be performed to exclude significant LM obstruction.
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Affiliation(s)
- L J Kajita
- Cardiac Catheterization Laboratory of the Heart Institute, University of São Paulo, São Paulo, Brazil
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Nemec J, Garratt KN, Schaff HV, Goodwin M, Morrow D, Brown A, Khandheria BK. Asymptomatic occlusion of the left main coronary artery by an aortic pseudoaneurysm. Mayo Clin Proc 2000; 75:1205-8. [PMID: 11075753 DOI: 10.4065/75.11.1205] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Extrinsic compression of the left main coronary artery is a rare cause of coronary ischemia. We describe a 35-year-old Asian woman with complete asymptomatic occlusion of the left main coronary artery by a large aortic pseudoaneurysm. She underwent repair of the pseudoaneurysm and coronary artery bypass grafting at the Mayo Clinic in Rochester, Minn. The differential diagnosis is discussed. Based on this patient's age and associated vascular lesions, we conclude that Takayasu arteritis was the most likely cause of her condition.
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Affiliation(s)
- J Nemec
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA
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37
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Sengupta PP, Saxena A, Rajani M. Left main coronary artery compression by aneurysmal pulmonary artery in a patient with tetralogy of Fallot with absent pulmonary valve. Catheter Cardiovasc Interv 1999; 46:438-40. [PMID: 10216010 DOI: 10.1002/(sici)1522-726x(199904)46:4<438::aid-ccd10>3.0.co;2-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We describe an 11-year-old girl with tetralogy of Fallot and absent pulmonary valve, who on selective coronary angiography was found to have extrinsic compression of the left main coronary artery by the aneurysmally dilated pulmonary artery. This abnormality has not been reported previously.
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Affiliation(s)
- P P Sengupta
- Department of Cardiology, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi
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Kawut SM, Silvestry FE, Ferrari VA, DeNofrio D, Axel L, Loh E, Palevsky HI. Extrinsic compression of the left main coronary artery by the pulmonary artery in patients with long-standing pulmonary hypertension. Am J Cardiol 1999; 83:984-6, A10. [PMID: 10190427 DOI: 10.1016/s0002-9149(98)01046-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Left main coronary artery compression by the pulmonary artery may be seen in patients with pulmonary hypertension who are undergoing cardiac catheterization. Cardiac magnetic resonance imaging is useful in these patients to document extrinsic compression, which might otherwise be mistaken for intrinsic atherosclerotic disease.
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Affiliation(s)
- S M Kawut
- Pulmonary Vascular Disease Program, Pulmonary and Critical Care Division, University of Pennsylvania Medical Center, Philadelphia, USA
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