Extrinsic compression of the left coronary ostium by the pulmonary trunk: management in a case of Eisenmenger syndrome

Tex Heart Inst J. 2010;37(1):95-8.

Abstract

Extrinsic compression of the left main coronary artery by a massively dilated pulmonary artery in patients who have severe pulmonary hypertension can lead to significant myocardial ischemia. A 58-year-old man with a large patent ductus arteriosus and Eisenmenger syndrome presented with angina at rest and worsening heart failure of 3 months' duration. The new symptoms were recognized to be secondary to extrinsic compression of the left main coronary artery ostium by a dilated main pulmonary artery and were successfully relieved by the placement of a metallic stent in the affected segment of the left main coronary artery. Multislice computed tomographic imaging after 6 months showed stent patency and the intimate relation of the stented vessel to the dilated main pulmonary trunk. We discuss diagnostic and management issues pertaining to this uncommon clinical entity.

Keywords: Angina pectoris/etiology; Eisenmenger complex/ complications; angioplasty, transluminal, percutaneous coronary; constriction, patho-logic/etiology; coronary stenosis/etiology; dilatation, pathologic/complications; ductus arteriosus, patent; hypertension, pulmonary/complications; stents; tomography, X-ray computed.

Publication types

  • Case Reports

MeSH terms

  • Angina, Unstable / etiology
  • Angioplasty, Balloon, Coronary* / instrumentation
  • Coronary Angiography / methods
  • Coronary Stenosis / diagnosis
  • Coronary Stenosis / etiology
  • Coronary Stenosis / therapy*
  • Dilatation, Pathologic
  • Ductus Arteriosus, Patent / complications
  • Eisenmenger Complex / complications*
  • Eisenmenger Complex / therapy
  • Heart Failure / etiology
  • Humans
  • Hypertension, Pulmonary / diagnosis
  • Hypertension, Pulmonary / etiology
  • Hypertension, Pulmonary / therapy*
  • Male
  • Metals
  • Middle Aged
  • Prosthesis Design
  • Pulmonary Artery / diagnostic imaging
  • Pulmonary Artery / pathology*
  • Stents
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Ventricular Dysfunction, Left

Substances

  • Metals