Extrinsic compression of the left main coronary artery by a dilated pulmonary artery: Clinical, angiographic, and hemodynamic determinants
- 2 January 2001
- journal article
- clinical trial
- Published by Wiley in Catheterization and Cardiovascular Interventions
- Vol. 52 (1) , 49-54
- https://doi.org/10.1002/1522-726x(200101)52:1<49::aid-ccd1012>3.0.co;2-0
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 (≥ 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, ≤ 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° left anterior oblique, 30° 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° ± 13°, a control group was 70° ± 15°). 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° to 50°). 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. Cathet Cardiovasc Intervent 2001;52:49–54.Keywords
This publication has 18 references indexed in Scilit:
- Extrinsic compression of the left main coronary artery by the pulmonary artery in patients with long-standing pulmonary hypertensionThe American Journal of Cardiology, 1999
- Unusual case of coronary stenosis caused by an external compressionInternational Journal of Cardiology, 1997
- Left Main Coronary Artery Compression During Primary Pulmonary HypertensionChest, 1997
- Submitral left ventricular aneurysm compressing the left main coronary arteryCatheterization and Cardiovascular Diagnosis, 1997
- Hochgradige Koronarstenose durch eine bronchogene Zyste*Deutsche Medizinische Wochenschrift (1946), 1995
- Experimental validation of geometric and densitometric coronary measurements on the new generation cardiovascular angiography analysis system (caas ii)Catheterization and Cardiovascular Diagnosis, 1993
- Angina pectoris due to left main coronary artery compression in Eisenmenger ductus arteriosusAmerican Heart Journal, 1993
- Left main coronary artery compression in patent ductus arteriosusAmerican Heart Journal, 1993
- Left main coronary trunk compression by dilated main pulmonary artery in atrial septal defectThe Journal of Thoracic and Cardiovascular Surgery, 1992
- External compression by metastatic squamous cell carcinoma: A rare cause of left main coronary artery narrowingClinical Cardiology, 1990