Left Main Coronary Artery Compression by the Pulmonary Trunk in Pulmonary Hypertension
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).
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, University Of Texas Medical School and Baylor College of Medicine.
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