title: Left Main Ostial Compression in a Patient with Pulmonary Hypertension: Dynamic Findings by IVUS.
abstract: BACKGROUND
  Pulmonary artery dilatation is a common feature among patients with severe pulmonary hypertension. Left main coronary artery extrinsic compression by an enlarged pulmonary artery is a rare complication and a potential cause for chest pain and sudden cardiac death in patients with pulmonary hypertension. This situation is very rare and few reports have described it. Currently, the appropriate management of these patients remains unknown.
  
  
  METHODS
  In the present report we describe the case of a 39-year-old woman who presented with a 2-year history of cardiac symptoms related to exercise. The patient underwent a 64-slice multidetector computed tomography (MDCT) coronary angiography, which showed left main coronary artery (LMCA) compression by a markedly enlarged pulmonary artery trunk (44 mm), without intraluminal stenosis or coronary artery calcium, as determined by the Agatston score. This compression was considered to be the cause of the cardiac symptoms. To confirm and plan the treatment, the patient underwent cardiac catheterization that confirmed the diagnosis of pulmonary hypertension and LMCA critical obstruction. Taking into account the paucity of information regarding the best management in these cases, the treatment decision was shared among a "heart team" that chose percutaneous coronary intervention with stent placement. An intra-vascular ultrasound was performed during the procedure, which showed a dynamic compression of the left main coronary artery. The intervention was successfully executed without any adverse events.
  
  
  CONCLUSIONS
  This case illustrates dynamic compression of the LMCA by IVUS, visually demonstrating the mechanism of the intermittent symptoms of myocardial ischemia in this kind of patient. It also shows that percutaneous stenting technique may be an appropriate treatment for this unusual situation.
authors.affiliation: Department of Cardiology, Hospital Totalcor, São Paulo, SP, Brazil.
authors.forename: Luciana F
authors.initials: LF
authors.lastname: Seabra
authors.affiliation: Department of Interventional Cardiology, Hospital Totalcor, São Paulo, SP, Brazil.
authors.forename: Henrique B
authors.initials: HB
authors.lastname: Ribeiro
authors.affiliation: Clinical Research, Hospital Totalcor, São Paulo, SP, Brazil.
authors.forename: Pedro Gabriel Melo
authors.initials: PG
authors.lastname: de Barros e Silva
authors.affiliation: Department of Cardiology, Hospital Totalcor, São Paulo, SP, Brazil.
authors.forename: Marcelo J
authors.initials: MJ
authors.lastname: Rodrigues
authors.affiliation: Department of Interventional Cardiology, Hospital Totalcor, São Paulo, SP, Brazil.
authors.forename: André G
authors.initials: AG
authors.lastname: Spadaro
authors.affiliation: Department of Interventional Cardiology, Hospital Totalcor, São Paulo, SP, Brazil.
authors.forename: Fábio
authors.initials: F
authors.lastname: Conejo
authors.affiliation: Department of Interventional Cardiology, Hospital Totalcor, São Paulo, SP, Brazil.
authors.forename: Roger R
authors.initials: RR
authors.lastname: Godinho
authors.affiliation: Department of Interventional Cardiology, Hospital Totalcor, São Paulo, SP, Brazil.
authors.forename: Sandro M M
authors.initials: SM
authors.lastname: Faig
authors.affiliation: Hospital Totalcor, São Paulo, SP, Brazil.
authors.forename: Thiago Andrade
authors.initials: TA
authors.lastname: de Macedo
authors.affiliation: Hospital Totalcor, São Paulo, SP, Brazil.
authors.forename: Luciana de P S
authors.initials: Lde P
authors.lastname: Baptista
authors.affiliation: Department of Echocardiography, Hospital Totalcor, São Paulo, SP, Brazil.
authors.forename: Marcos Valerio C
authors.initials: MV
authors.lastname: de Resende
authors.affiliation: Hospital Totalcor, São Paulo, SP, Brazil.
authors.forename: Valter
authors.initials: V
authors.lastname: Furlan
authors.affiliation: Department of Interventional Cardiology, Hospital Totalcor, São Paulo, SP, Brazil.
authors.forename: Expedito E
authors.initials: EE
authors.lastname: Ribeiro
mesh_terms: D000328:Adult; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D061330:Multidetector Computed Tomography; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D018084:Ultrasonography, Interventional / Q000379:methods*