Acute coronary syndrome due to extrinsic compression of the left main coronary artery in a patient with severe pulmonary hypertension: successful treatment with percutaneous coronary intervention.
A patient with severe pulmonary (arterial) hypertension (PH) presented with a non-ST segment elevation myocardial infarction and recurrent angina at rest. Coronary angiography showed severe ostial left main coronary artery (LMCA) stenosis; coronary arteries were otherwise normal. Intravascular ultrasonography (IVUS) showed deformation of the LMCA due to extrinsic compression from a markedly dilated main pulmonary artery, which was confirmed by cardiac computed tomography. The LMCA was successfully stented using a paclitaxel-eluting stent resulting in complete resolution of angina. Extrinsic compression of the LMCA should be considered in patients with severe PH and angina; IVUS may aid in the diagnosis. Percutaneous stent implantation may be the preferred treatment in this high-risk group of patients.
Lindsey
Jason B
JB
Division of Cardiovascular Diseases, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Brilakis
Emmanouil S
ES
Banerjee
Subhash
S
D054058:Acute Coronary Syndrome / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D000787:Angina Pectoris / Q000209:etiology / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation; D002317:Cardiovascular Agents / Q000008:administration & dosage; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D004108:Dilatation, Pathologic; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000473:pathology / Q000628:therapy; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011651:Pulmonary Artery / Q000473:pathology*; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
D002317:Cardiovascular Agents; D010975:Platelet Aggregation Inhibitors; D017239:Paclitaxel