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Review
. 2018 May 15;57(10):1421-1424.
doi: 10.2169/internalmedicine.9534-17. Epub 2018 Jan 11.

Percutaneous Coronary Intervention for a Patient with Left Main Coronary Compression Syndrome

Ryutaro Ikegami  1 , Kazuyuki Ozaki  1 , Takuya Ozawa  1 , Satoru Hirono  1 , Masahiro Ito  1 , Tohru Minamino  1
Affiliations
Review

Percutaneous Coronary Intervention for a Patient with Left Main Coronary Compression Syndrome

Ryutaro Ikegami et al. Intern Med. .

Abstract

Left main coronary compression syndrome rarely occurs in patients with severe pulmonary hypertension. A 65-year-old woman with severe pulmonary hypertension due to an atrial septal defect suffered from angina on effort. Cardiac computed-tomography and coronary angiography revealed considerable stenosis of the left main coronary artery (LMA) caused by compression between the dilated main pulmonary artery trunk and the sinus of valsalva. Stenting of the LMA under intravascular ultrasound imaging was effective for the treatment of angina. We herein report the diagnosis and management of this condition with a brief literature review.

Keywords: Eisenmenger syndrome; dilated main pulmonary artery; pulmonary hypertension; revascularization for left main coronary artery.

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Figures

Figure 1.
Figure 1.
(A) CT showed marked enlargement of the pulmonary artery due to severe PH. (B, C, D) The compression of the LMCA (white arrow) by the dilated pulmonary artery trunk and sinus of valsalva was confirmed by CTA.
Figure 2.
Figure 2.
(A) Cardiac angiography confirmed narrowing of the LMCA by 90%. (B, C, D) IVUS demonstrated no significant atheroma in the LAD proximal portion. (B) From the proximal LAD to the LMCA ostium, there was superficial calcification and deformation with a slit-like appearance due to compression by the reduced echoic space in both sides. (E, F) Post-stenting angiography and IVUS showed the complete resolution of the LMCA stenosis.
Figure 3.
Figure 3.
(A, B) The stent patency at three months after the PCI was confirmed by coronary CTA (white arrow).
See this image and copyright information in PMC

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