Percutaneous intervention of left main coronary artery compression by pulmonary artery aneurysm.
BACKGROUND
Extrinsic compression of the left main coronary artery (LMCA) by a pulmonary artery aneurysm (PAA) has become increasingly recognized as an etiology of angina in patients with pulmonary arterial hypertension (PAH). The purpose of this study was to assess the feasibility and efficacy of LMCA stenting in the treatment LMCA stenosis because of PAA.


METHODS
Retrospective analysis of data on patients with PAH who presented with angina and underwent percutaneous intervention of their LMCA compression because of PAA was performed.


RESULTS
Five patients (age 51 ± 16 years, all female) with PAH presented with angina and underwent LMCA stenting between 2007 and 2009. Four had positive cardiac enzymes. LMCA compression because of a PAA was diagnosed in all patients with cardiac CT angiography after echocardiography demonstrated an enlarged pulmonary artery. LMCA stenting was successfully performed in all patients with resolution of angina and electrocardiographic abnormalities. After a mean follow-up of 16.6 ± 15.7 months (range of 5-39 months), patients remained angina free, no complications of the procedure were noted, and long term stent patency was confirmed in three of the five patients who underwent repeat cardiac CT angiography.


CONCLUSIONS
LMCA stenting appears to be a feasible and durable option in patients who present with angina because of compression by PAA. This procedure was well tolerated and is of particular value given the increased surgical risk in patients with PAH.
Vaseghi
Marmar
M
Division of Cardiology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA. mvaseghi@mednet.ucla.edu
Lee
Michael S
MS
Currier
Jesse
J
Tobis
Jonathan
J
Shapiro
Shelley
S
Aboulhosn
Jamil
J
D000328:Adult; D000368:Aged; D000783:Aneurysm / Q000175:diagnosis / Q000209:etiology*; D000787:Angina Pectoris / Q000209:etiology / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D004452:Echocardiography; D005240:Feasibility Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000175:diagnosis; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency