Extrinsic compression of the left coronary ostium by the pulmonary trunk: management in a case of Eisenmenger syndrome.
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.
Sivakumar
Kothandam
K
Department of Cardiology, MIOT Hospital, Manapakkam, Chennai 600089, India. drkumarsiva@hotmail.com
Rajan
Maruthanayagam
M
Francis
Gnanapragasam
G
Murali
Krishnaswami
K
Bashi
Velayudhan
V
D000789:Angina, Unstable / Q000209:etiology; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation; D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D004108:Dilatation, Pathologic; D004374:Ductus Arteriosus, Patent / Q000150:complications; D004541:Eisenmenger Complex / Q000150:complications* / Q000628:therapy; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D008297:Male; D008670:Metals; D008875:Middle Aged; D011474:Prosthesis Design; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000473:pathology*; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left
D008670:Metals