Likelihood of left main coronary artery compression based on pulmonary trunk diameter in patients with pulmonary hypertension

Mesquita, Sonia M. F.; Castro, Rbp; Ikari, Nana Miura; Oliveira, Susana; Lopes, Artur

doi:10.1016/j.accreview.2004.04.057

Cited by 79 publications

(70 citation statements)

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“…[15][16][17][18] Congenital and postoperative abnormalities of CA anatomy associated with conotruncal defects are well known. 19,20 Even in patients with normal CA anatomy, rotation or anterior displacement of the aorta, or variations in surgical reimplantation of the CAs (eg, with a Ross procedure or arterial switch), may alter the location of the CAs enough to put the patient at risk, depending on the relative position of the RVOT conduit, which can also vary.…”

Section: Circ Cardiovasc Intervmentioning

confidence: 99%

Risk of Coronary Artery Compression Among Patients Referred for Transcatheter Pulmonary Valve Implantation

Morray

McElhinney

Cheatham

et al. 2013

Circ: Cardiovascular Interventions

206

138

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Background-The Melody transcatheter pulmonary valve (TPV) was approved for implantation in obstructed right ventricular outflow tract conduits in 2010 after a multicenter trial demonstrating improvements in conduit obstruction, regurgitation, and right ventricular pressure. A recognized risk and contraindication to TPV implantation is the demonstration of coronary artery (CA) compression during balloon angioplasty or stent placement in the overlying conduit. This study is the first to characterize the risk of CA compression in this population. Methods and Results-From

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Section: Circ Cardiovasc Intervmentioning

confidence: 99%

Risk of Coronary Artery Compression Among Patients Referred for Transcatheter Pulmonary Valve Implantation

Morray

McElhinney

Cheatham

et al. 2013

Circ: Cardiovascular Interventions

206

138

View full text Add to dashboard Cite

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“…3 The incidence of LMCA compression due to PA dilatation is not well known but ranges between 5% and 44%, according to different case series. 4,5 In contrast to atherosclerotic coronary artery disease, which is more common in elderly males, extrinsic LMCA compression appears to affect younger people and may have a higher incidence in women. 6 Because of a low pretest probability for atherosclerotic coronary artery disease in young PH patients, coronary angiography is rarely performed.…”

Section: Discussionmentioning

confidence: 99%

Left Main Coronary Artery Compression in Pulmonary Arterial Hypertension

Albadri¹,

Jensen²,

Christiansen³

et al. 2015

Pulm. circ.

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In patients with pulmonary arterial hypertension (PAH), chest pain is most likely due to right ventricular demand ischemia. We report a patient with idiopathic PAH who developed severe angina due to extrinsic compression of the left main coronary artery (LMCA) from a dilated pulmonary artery trunk. The diagnosis was verified by electrocardiogram after exercise, coronary angiography including intravascular ultrasound, and cardiac multidetector computed tomography (MDCT). The origin of the LMCA was high in the left coronary sinus, facilitating extrinsic compression. The patient was successfully treated by percutaneous coronary intervention with stent implantation in the LMCA. Extrinsic compression of the LMCA is a severe and potentially fatal complication that should be considered in all patients with PAH and angina. MDCT is the method of choice for first-line diagnosis.Keywords: pulmonary hypertension, chest pain, left main coronary artery. CASE DESCRIPTIONIdiopathic pulmonary arterial hypertension (IPAH) was diagnosed in a 49-year-old woman 6 years ago. She was classified as World Health Organization (WHO) functional class (FC) III at the time of diagnosis, but during treatment with an endothelin receptor antagonist (ambrisentan), she improved considerably and became stable in WHO FC II, with a 6-minute walk test distance of ≥400 m. She was seen at regular intervals of 4-6 months in our outpatient pulmonary hypertension (PH) clinic. During the latest visit, the patient reported increasing dyspnea and tightening chest pain during physical activity. She had no family history or other risk factors for coronary artery disease. On suspicion of worsening PAH, she was admitted to our PH ward for further evaluation.Physical examination revealed a normal blood pressure of 110/80 mmHg, heart rate of 80 beats/minute, and no sign of right-or left-sided heart failure. Transthoracic echocardiography revealed a moderately dilated right ventricle (RV) with an estimated systolic RV pressure of 100 mmHg and a tricuspid annular plane systolic excursion of 1.3 cm. The left ventricle (LV) was small (end-diastolic diameter: 2.8 cm) with a mildly depressed LV systolic function (LV ejection fraction: 50%). The main pulmonary artery (PA) was severely dilated (diameter: 42 mm) and later was visualized to be immediately adjacent to the takeoff of the left main coronary artery (LMCA). During a 6-minute walk test, the patient developed severe tightness around the chest after a 5-m walk and was unable to complete the test. An acute 12-lead electrocardiogram (ECG) showed ST segment depression in the inferior and the anterolateral leads compared with the resting 12-lead ECG (Fig. 1).Coronary arteriography was performed from the right femoral artery and demonstrated a severe ostial LMCA stenosis (Fig. 2). The LMCA originated from a high position in the left sinus of the aortic root. There were no other atherosclerotic changes or stenosis of the coronary arteries. Intravascular ultrasound (IVUS) showed that the ostium of the LMCA was ...

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“…1,2 Chest pain is often ascribed to right ventricular ischemia associated with normal coronary anatomy or left main coronary artery compression. [3][4][5][6] However, pulmonary vascular conditions such as pulmonary artery dissection or pulmonary embolism are also associated with chest pain. Symptoms associated with pulmonary artery dissection include chest pain, fatigue, and progressive dyspnea.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 In patients with PAH, the cause of chest pain is unclear but is commonly attributed to myocardial ischemia. [3][4][5][6] However, acute pulmonary artery dissection is also associated with new-onset chest pain, often with fatal outcomes. 7,8 We describe a patient who had progressively worsening idiopathic PAH and chest pain, which resolved after initiation of intravenous prostaglandin analog therapy, and was found to have had acute and chronic pulmonary artery dissections on postmortem examination.…”

mentioning

confidence: 99%

Chronic Pulmonary Artery Dissection Associated with Pulmonary Arterial Hypertension

Cook

Duarte²,

Boor

et al. 2013

Pulm. circ.

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Pulmonary artery dissection is a complication associated with pulmonary arterial hypertension. This complication is described as acute in onset and is frequently fatal without intervention. We describe a patient with idiopathic pulmonary arterial hypertension and chest pain found to have an unsuspected chronic pulmonary artery dissection on postmortem examination. Chronic pulmonary artery dissection should be considered in patients with chest pain and worsening dyspnea, as the frequency this condition may be underestimated.Keywords: pulmonary arterial hypertension, pulmonary artery dissection, complication, chest pain. Pulmonary artery hypertension (PAH) is a progressive, life-threatening condition associated with symptoms that become more prevalent with disease progression. 1,2 In patients with PAH, the cause of chest pain is unclear but is commonly attributed to myocardial ischemia. [3][4][5][6] However, acute pulmonary artery dissection is also associated with new-onset chest pain, often with fatal outcomes. 7,8 We describe a patient who had progressively worsening idiopathic PAH and chest pain, which resolved after initiation of intravenous prostaglandin analog therapy, and was found to have had acute and chronic pulmonary artery dissections on postmortem examination. CASE DESCRIPTIONA 56-year-old female with idiopathic PAH diagnosed 11 years earlier and treated with nifedipine, bosentan (Tracleer, Actelion, San Francisco), sildenafil (Revatio, Pfizer, New York), inhaled iloprost (Iloprost, Actelion, San Francisco), and warfarin presented with 2 weeks of severe, intermittent chest pain. Chest pain was sharp and nonradiating, located over the left anterior chest, lasting 20-60 minutes, and aggravated with exertion or deep inspiration. This pain was unrelieved by antacids and partially relieved by oxygen and rest. Physical examination revealed a pulse rate of 100/minute, blood pressure of 130/70 mmHg, and pulse oximetry of 96% (with oxygen administered at 2 L/min). Chest auscultation revealed clear lung fields, a 3/6 systolic murmur, and no pericardial rub. No chest wall tenderness was elicited. Ascites was absent, and lower-extremity edema was present. Initial and subsequent electrocardiographs during episodes of chest pain revealed tachycardia without ischemic changes. Concomitant serum troponin levels were normal. A single-photon emission computed tomography (CT) myocardial perfusion test with adenosine did not demonstrate perfusion defects. Echocardiography

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Likelihood of left main coronary artery compression based on pulmonary trunk diameter in patients with pulmonary hypertension

Cited by 79 publications

References 0 publications

Risk of Coronary Artery Compression Among Patients Referred for Transcatheter Pulmonary Valve Implantation

Risk of Coronary Artery Compression Among Patients Referred for Transcatheter Pulmonary Valve Implantation

Left Main Coronary Artery Compression in Pulmonary Arterial Hypertension

Chronic Pulmonary Artery Dissection Associated with Pulmonary Arterial Hypertension

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