A case of acute coronary syndrome caused by extrinsic compression of the left main coronary artery due to pulmonary hypertension

Kawase, Tomoharu; Ueda, Hironori; Watanabe, Noriaki; Motoda, Chikaaki; Takeda, Ryo; Mito, Shinji; Tamekiyo, Hiromichi; Otsuka, Masaya; Okimoto, Tomokazu; Toyofuku, Mamoru; Hirao, Hidekazu; Muraoka, Yuji; Masaoka, Yoshiko; Hayashi, Yasuhiko

doi:10.1016/j.jccase.2010.06.002

Cited by 6 publications

(3 citation statements)

References 15 publications

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“…Coronary artery bypass graft (CABG) as a treatment option of this syndrome involves a higher risk in general anaesthesia and cardiopulmonary bypass (CPB) in sick patients with deranged renal and liver function, so Percutaneous Coronary Intervention (PCI) with a drug eluting stent (DES) of good radial strength may be the preferred strategy in such selected individuals. [7][8][9]…”

Section: Discussionmentioning

confidence: 99%

The Mechanical Cause of Myocardial Infarction in Eisenmenger Syndrome: Unidimensional Left Main Compression

Bhatia

2024

CRR

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Eisenmenger syndrome may rarely present as acute coronary syndrome due to extrinsic left main compression by the dilated and hypertensive pulmonary artery. Though computed tomography (CT scan) has been the investigation of choice for diagnosis of this entity, high-definition intravascular ultrasound (HD-IVUS) may play a crucial role in diagnosis especially in sick patients with a characteristic finding of a “slit-like” ostia. Treatment of this “left main compression syndrome” with a drug eluting stent of high radial strength, evidenced angiographically as well as by HD-IVUS makes percutaneous coronary intervention (PCI) a preferred strategy to coronary artery bypass graft (CABG) in such high-risk patients.

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Section: Discussionmentioning

confidence: 99%

The Mechanical Cause of Myocardial Infarction in Eisenmenger Syndrome: Unidimensional Left Main Compression

Bhatia

2024

CRR

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“…Atypical angina Post-surgical PDA, Eisenmenger syndrome MSCT: MPA diameter 63 mm Angiography: severe ostial and proximal stenosis of LMCA IVUS-guided PCI Symptoms improvement and CT evaluation after 6 months revealed patent stent Tomoharu Kawase, Hironori Ueda. 2010 [ 38 ] Male, 43 years old. Typical angina Group 3 PH MSCT: dilated MPA Angiography: severe stenosis of LM IVUS-guided PCI Angiography evaluation after 3 months showed good stent position Tobias Koppara, Julinda Mehilli.…”

Section: Discussionmentioning

confidence: 99%

Eisenmenger syndrome with left main compression syndrome: a case report

Cool

Fathini

Adams

et al. 2022

BMC Cardiovasc Disord

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Background Left main coronary artery disease secondary to pulmonary artery compression related to Eisenmenger syndrome is an under-suspected condition that can cause fatal outcomes if left untreated. It presents with typical angina but is frequently mistaken for pulmonary hypertension (PH) symptoms. It is now recognized as one of the few important causes of angina in PH. Case presentation A 37-year-old man with a history of unoperated atrial septal defect and Eisenmenger syndrome came to the outpatient department with a chief complaint of angina on exertion. Electrocardiogram showed regular sinus rhythm with right axis deviation, right ventricular hypertrophy, deep T-wave inversion in inferior and anterior leads suggestive of ischemia or strain, and incomplete right bundle branch block. Cardiac CT showed compression of the left main coronary artery due to a dilated main pulmonary artery. Therefore, this patient was diagnosed with Eisenmenger syndrome with left main compression due to dilated pulmonary artery. He was treated successfully with IVUS-guided stent implantation. The patient experienced marked improvement in regular activities, with no recurrence of angina symptoms. Angiography 3 months after the procedure revealed good patency of the stent, without significant stenosis. Conclusions Left main coronary artery compression is a complication that should be suspected in patients with Eisenmenger syndrome presenting with angina symptoms. Non-invasive modalities are recommended for diagnostic evaluation, but the gold-standard technique remains coronary angiography. The best treatment is not well-established, with either myocardial revascularization or PH treatment, but a left main coronary artery stenting procedure is considered an ideal emergent treatment to provide a better quality of life for patients in this condition.

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“…Синдром сдавления ствола левой коронарной артерии расширенным стволом легочной артерии (ЛА) является редким осложнением у пациентов с легочной гипертензией и был впервые описан Corday и соавт. в 1957 году как причина коронарной недостаточности у пациентов с ЛГ [33,84]. Синдром сдавления ствола ЛКА является причиной возникновения боли в груди по типу стенокардии и приводит к дисфункции левого желудочка и даже к внезапной сердечней смерти у пациентов с ЛГ.…”

Section: автор ответственный за связь с редакцией: быков александр ни...unclassified

Left Main Coronary Artery Compression Syndrome in Patient With Pulmonary Arterial Hypertension. First Clinical Experience

Bykov,

Arkhipov,

Klimusheva

et al. 2018

Evrazijskij kardiologičeskij žurnal

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Chest pain remains a common complaint in patients with pulmonary arterial hypertension (PAH). Compression of the coronary arteries is rare and probably underestimated syndrome being a typical cause of angina pectoris in patients with severe pulmonary arterial hypertension. Compression of the left main coronary artery (LMCA) by an enlarged pulmonary trunk is oftentimes associated with angina pectoris, but appropriate approaches to diagnosis and treatment remain poorly defined. This is a clinical case of a 38 years-old woman with idiopathic pulmonary arterial hypertension (IPAH) who has suffered from myocardial ischemia due to compression of the LMCA by a pulmonary artery aneurysm. The diagnosis of LMCA compression was made by coronary angiography (CA) and multispiral computed tomography (MSCT), which confirmed the pulmonary artery aneurysm as a source of external compression. LMCA stenting and changing in the PAH-specific therapy led to a significant improvement in angina, heart function and quality of life. Percutaneous coronary intervention appears to be feasible, safe and effective treatment for patients with external compression of the left coronary artery from pulmonary artery enlargement.

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A case of acute coronary syndrome caused by extrinsic compression of the left main coronary artery due to pulmonary hypertension

Cited by 6 publications

References 15 publications

The Mechanical Cause of Myocardial Infarction in Eisenmenger Syndrome: Unidimensional Left Main Compression

The Mechanical Cause of Myocardial Infarction in Eisenmenger Syndrome: Unidimensional Left Main Compression

Eisenmenger syndrome with left main compression syndrome: a case report

Left Main Coronary Artery Compression Syndrome in Patient With Pulmonary Arterial Hypertension. First Clinical Experience

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