Abstract 18437: Chest Pain in the Setting of Massive Pulmonary Artery Dilation
Introduction: Giant pulmonary artery aneurysms are rare. They may be present in congenital heart anomalies with intra-cardiac shunting and pulmonary hypertension or in absent pulmonic valve syndrome. In the presence of severe pulmonary hypertension there are case reports of these aneurysms causing left main coronary artery compression.
Case: A fifty-two year old woman with a history of an atrial septal defect and prior pulmonary valvotomy at age 8 presented to an outside emergency room with severe chest pain. She had a history of chronic atrial fibrillation and mitral valve repair for severe mitral regurgitation ten years earlier. On presentation, she was in atrial fibrillation with rapid ventricular response and hypotensive with a blood pressure of 86/50 Her exam was significant for a soft diastolic murmur a 2/6 ejection systolic murmur, her lungs were clear and she had no pedal edema. Her laboratory data was significant for elevated troponin of 95ng/L and Creatinine phosphokinase of 2537 u/L. ECG showed no significant ST changes. An echocardiogram obtained showed borderline reduced left ventricular function with apical hypokinesis and normal right ventricular function. She also had a dilated pulmonic annulus of ~2.9cm with mild to moderate pulmonary regurgitation and a severely dilated main pulmonary artery of ~6.5cm. Right heart catheterization showed a mean pulmonary artery pressure of 39mm Hg. Coronary artery angiography suggested narrowing of the LAD with early tapering as well as a small and narrow left main with impaired filling raising concern of external compression of the artery. Computed tomography demonstrated no pulmonary artery dissection. On 3D reconstruction the left main origin was angulated and apparently displaced by mass effect of the very large pulmonary artery. She underwent distal MPA reconstruction and bio-prosthetic pulmonic valve replacement without coronary artery bypass. She had no recurrence of her chest pain.
Conclusion: This is an unusual case of left main coronary artery compression by a giant pulmonary artery aneurysm in the absence of severe pulmonary hypertension.
Author Disclosures: A. Sabanayagam: None. I. Harris: None. A. Agarwal: None. N. Cambronero: None. E. Foster: None.
- © 2016 by American Heart Association, Inc.