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(Circulation. 2002;105:265.)
© 2002 American Heart Association, Inc.

Images in Cardiovascular Medicine

Left Main Coronary Artery Compression by the Pulmonary Trunk in Pulmonary Hypertension

Diana Bonderman, MD; Dominik Fleischmann, MD; Mathias Prokop, MD; Walter Klepetko, MD; Irene M. Lang, MD

From the Departments of Cardiology (D.B., I.M.L.), Radiology (D.F., M.P.), and Cardiothoracic Surgery (W.K.), University of Vienna, Vienna, Austria.

Correspondence to Irene M. Lang, MD, Department of Internal Medicine II, Division of Cardiology, University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria. E-mail irene.lang@univie.ac.at

After a 14-year-history of chronic thromboembolic pulmonary hypertension with gradual clinical deterioration, a 62-year-old woman finally agreed to surgical pulmonary thromboendarterectomy. Routine preoperative coronary angiography demonstrated an ostial stenosis of the left main coronary artery (LM). Intravascular ultrasound disclosed a pristine vessel, with no evidence of atherosclerotic plaque (Figure, A, insert a) and a 4.5-mm poststenotic dilatation (Figure, A, insert b). Because extrinsic compression of the LM was suspected, ECG-gated, multislice computed tomography was performed. A markedly dilated main pulmonary artery compressed and downward displaced the LM (Figure, B). Two weeks after successful pulmonary thromboendarterectomy, size regression of the pulmonary artery and remodeling of the LM and left anterior descending coronary artery were encountered (Figure, C).

View larger version (103K): [in this window] [in a new window]   A, Coronary angiogram in the left anterior oblique, 45-degree cranial, 15-degree projection demonstrates slit-like compression of the LM and poststenotic dilation of the LM and left anterior descending coronary artery (LAD). Cross-sectional intravascular ultrasound views are shown in the insets. B and C, Multislice computed tomography–angiography. The curved planar reformation oriented along the LM and proximal left anterior descending coronary artery demonstrates that the enlarged main pulmonary artery compresses the LM (arrow, B). Two weeks after successful pulmonary thromboendarterectomy, the compression has resolved (arrow, C). LCX indicates left circumflex artery; PA, pulmonary artery; and AO, aorta.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, . . . [Full Text of this Article]

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