23 December 2015 : Case report
Left Main Ostial Compression in a Patient with Pulmonary Hypertension: Dynamic Findings by IVUS
Challenging differential diagnosis, Unusual setting of medical care, Educational Purpose (only if useful for a systematic review or synthesis), Rare coexistence of disease or pathology
Luciana F. SeabraABCDEF, Henrique B. RibeiroABCDEF, Pedro Gabriel Melo de Barros e SilvaCDEFG, Marcelo J. RodriguesBCD, André G. SpadaroBD, Fábio ConejoBD, Roger R. GodinhoBD, Sandro M. M. FaigBD, Thiago Andrade de MacedoE, Luciana de P. S. BaptistaC, Marcos Valerio C. de ResendeB, Valter FurlanDG, Expedito E. RibeiroBCDEDOI: 10.12659/AJCR.895668
Am J Case Rep 2015; 16:899-903
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.
CASE REPORT: 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.
Keywords: Coronary Angiography, Coronary Occlusion - ultrasonography, Follow-Up Studies, Hypertension, Pulmonary - ultrasonography, multidetector computed tomography, Pulmonary Artery - ultrasonography, Ultrasonography, Interventional - methods
In Press
05 Mar 2024 : Case report
Simultaneous Transcatheter Closure of a Ventricular Septal Defect and Pulmonary Valvuloplasty: A Case ReportAm J Case Rep In Press; DOI: 10.12659/AJCR.942032
06 Mar 2024 : Case report
Successful Healing of Periapical Pathology with Partial Pulpotomy in a Mature Permanent Molar: A Case ReportAm J Case Rep In Press; DOI: 10.12659/AJCR.942937
12 Mar 2024 : Case report
Successful Treatment of Lithium-Induced Nephrogenic Diabetes Insipidus with Celecoxib: A Promising Therapeu...Am J Case Rep In Press; DOI: 10.12659/AJCR.943244
13 Mar 2024 : Case report
Recurrent Marginal Zone Lymphoma with Bone Marrow Involvement Detected by ¹⁸F-FDG PET/CT and Biopsy: A Diag...Am J Case Rep In Press; DOI: 10.12659/AJCR.943275
Most Viewed Current Articles
07 Mar 2024 : Case report
Neurocysticercosis Presenting as Migraine in the United StatesDOI :10.12659/AJCR.943133
Am J Case Rep 2024; 25:e943133
10 Jan 2022 : Case report
A Report on the First 7 Sequential Patients Treated Within the C-Reactive Protein Apheresis in COVID (CACOV...DOI :10.12659/AJCR.935263
Am J Case Rep 2022; 23:e935263
19 Jul 2022 : Case report
Atlantoaxial Subluxation Secondary to SARS-CoV-2 Infection: A Rare Orthopedic Complication from COVID-19DOI :10.12659/AJCR.936128
Am J Case Rep 2022; 23:e936128
23 Feb 2022 : Case report
Penile Necrosis Associated with Local Intravenous Injection of CocaineDOI :10.12659/AJCR.935250
Am J Case Rep 2022; 23:e935250