Extrinsic compression of left main coronary artery by aneurysmal pulmonary artery in severe pulmonary hypertension: its correlates, clinical impact, and management strategies

Abstract

Our study demonstrates that LMCA-Co is one of the most important and potentially lethal complications of severe PH, and alertness for this risk seems to be necessary in specific circumstances related with PAA. However, long-term benefit from stenting in this setting remains as a controversy.

Utility of CT Angiography for the Prediction of Coronary Artery Compression in Patients Undergoing Transcatheter Pulmonary Valve Replacement

“…Our study supports previously published risk factors for CC, such as anomalous course of coronary arteries and proximity of the RVOT to the coronary arteries. 6,7 Moreover, our study adds to the current body of research on this topic by further defining these risk factors through CTA measurements and exploring the interplay of risk factors in predicting CC.…”

“…5,6 Abbreviations and Acronyms The published potential risk factors for CC are anomalous course of the coronary arteries, pulmonary arterial hypertension, coronary artery proximity to the RVOT, and a diagnosis of transposition of the great arteries. 6,7 There is little data on the utility of preprocedural chest computed tomography angiography (CTA) for the evaluation of CC risk. One possible risk assessment tool is the measurement of the distance between the proposed valve deployment location in the RVOT and the nearest coronary artery.…”

Left Main Coronary Artery Occlusion By External Compression With A Large Pulmonary Artery in Eisenmenger Syndrome

“…Sudden cardiac death is a common mode of mortality in patients with PAH, and it may be related with mechanical complications (1). The severe LMCA compression rate was 8.2% in a recent study and required intervention in most of the patients (2). The LMCA compression risk is related to the PA diameter.…”

“…Idiopathic, iatrogenic, infectious or connective tissue diseases, and vasculitis can cause a PA aneurysm, but the majority of the cases are related with congenital heart disease and PAH (3). As the LMCA compression can exist without anginal symptoms, physicians should be aware of the sudden death risk, and computed tomography should be performed to define the LMCA compression in patients at risk; particularly if the PA diameter is over 40 mm, ensuring the existence of a PA aneurysm (1,2). Recent evidence indicates the coronary stenting as a viable option for resolution of LMCA compression (2).…”

Left main coronary artery compression by pulmonary artery aneurism in patients with long standing pulmonary arterial hypertension

“…Авторами сформулированы предикторы развития компрессии ЛКА, к основным из которых относятся диаметр ствола ЛА более 40 мм (чувствительность 83 %, специфичность 70 %) и соотношение диаметров ЛА к аорте более 1,5 (чувствительность 73 %, специфичность 70 %) [20]. Из до полнительных ФР при анализе МСКТ изображений следует обращать внимание на угол отхождения ЛКА от синуса аорты, который, по данным Ozgur Y. с соавт., при значении менее 30º коррелирует с тяжестью стеноза ЛКА [19]. Следует отметить, что, по данным большинства исследователей, размеры аневризмы ЛА и соответственно частота развития компрессии ЛКА зависят не от тяжести течения ЛАГ, а от длительности заболевания [21].…”