Extrinsic Compression of the Left Main Coronary Artery by Atrial Septal Defect

Jo, Yusuke; Kawamura, Akio; Jinzaki, Masahiro; Kohno, Takashi; Anzai, Toshihisa; Iwanaga, Shiro; Kokaji, Kiyokazu; Yoshikawa, Tsutomu; Yozu, Ryohei; Kuribayashi, Sachio; Ogawa, Satoshi

doi:10.1016/j.athoracsur.2008.05.046

Cited by 14 publications

(7 citation statements)

References 7 publications

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“…The optimal management of symptomatic patients remains unknown [2,4]. In patients with a congenital defect and potentially reversible pulmonary hypertension, the correction of the congenital defect, occasionally associated with CABG [5], have been shown to decrease the degree of LMCA compression. For patients with irreversible pulmonary hypertension and significantly increased predicted surgical mortality, LMCA stenting has been favoured as the revascularization strategy of choice, at least for the short-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

Left main coronary artery compression by a left sinus of Valsalva aneurysm

Martínez‐Comendador

Gualis

Martín

et al. 2013

Interactive CardioVascular and Thoracic Surgery

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Myocardial ischaemia due to extrinsic left main coronary artery compression is unusual. Most cases are related to pulmonary hypertension with severe main pulmonary artery dilatation. An extremely rare cause is a left sinus of Valsalva aneurysm (SVA). We describe the case of a patient diagnosed of left SVA after a coronary angiography and aortography, whose initial clinical manifestation was an acute coronary syndrome complicated with an out-hospital resuscitated sudden cardiac death.Keywords: Aneurysm (aortic root) • Aortic operation • Coronary artery bypass grafts surgery CASE REPORTOn November 2011, a previously asymptomatic hypercholesterolemic 55-year old man was referred to our hospital for surgical repair after an out-of-hospital resuscitated sudden cardiac death after finishing a marathon caused by left main coronary artery (LMCA) compression by a sinus of Valsalva aneurysm (SVA). No neurological sequelae remained. He had no additional cardiovascular risk factors. On admission, physical examination and laboratory data, including cardiac enzyme levels, revealed no abnormalities. On chest X-ray, no increased cardiothoracic ratio or focal lung lesions were demonstrated and no ischaemic changes were suggested on EKG.Transthoracic and transoesophageal echocardiography demonstrated a 50-mm aortic root aneurysm with an asymmetrically enlarged left coronary sinus of Valsalva with normal heart valve function, confirmed during aortography ( Fig. 1A and B). On coronary angiography (Fig. 1C), an associated severe (70%) concentric ostial and proximal LMCA stenosis was observed, with no other significant coronary stenosis, and urgent surgical correction was indicated. Intraoperative findings included a global dilated aortic root and an asymmetric left SVA with diffuse calcified plaques and intimal ulcers extended through aortic annulus, making very difficult valve-preserving aortic root reconstruction, so we decided to perform an aortic root and valve replacement with a mechanical composite valve conduit (St Jude Medical, St Paul, MN, USA). The LMCA was compressed and enlarged by the aneurysm with a long proximal portion inlaid in its wall. The left anterior descending artery had an intramyocardial distribution on its proximal and mid portions. During coronary button tailoring, the LMCA was unavoidably transected and therefore was ligated. Coronary reconstruction included right coronary artery reimplantation and coronary artery bypass grafting (CABG) to the distal left anterior descending artery and first obtuse marginal branch with both internal thoracic arteries. On weaning of cardiopulmonary bypass ischaemic ST-segment changes were observed on precordial leads with associated echocardiographic basal anterior acinesia, and a supplemental vein graft to the first diagonal branch was performed. Afterwards, the postoperative course was uneventful. Anatomopathological analysis of the aortic root wall demonstrated atherosclerotic changes.At 3-month follow-up, the patient remained asymptomatic on New York Heart Asso...

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Section: Discussionmentioning

confidence: 99%

Left main coronary artery compression by a left sinus of Valsalva aneurysm

Martínez‐Comendador

Gualis

Martín

et al. 2013

Interactive CardioVascular and Thoracic Surgery

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“…The treatment of symptomatic extrinsic compression of the LMCA remains controversial. Coronary artery bypass graft surgery and unprotected LMCA stent implantation are currently the only available revascularization strategies (4,5). Due to the high rate of surgical mortality among patients with PH, LMCA stenting is usually favored for revascularization strategy (6).…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Coronary Intervention for Left Main Compression Syndrome due to Severe Idiopathic Pulmonary Arterial Hypertension: One Year Follow-up Using Intravascular Imaging

et al. 2015

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A 60-year-old woman presented with ST-elevation myocardial infarction due to extrinsic compression of the left main coronary artery (LMCA) caused by a dilated pulmonary artery (PA) with idiopathic pulmonary hypertension and was successfully treated with intravascular ultrasound-and optical coherence tomographyguided stenting. Continuous subcutaneous epoprostenol infusion therapy was initiated immediately after the procedure and increased aggressively. Imaging modalities were extremely useful in making the diagnosis and providing follow-up of LMCA compression syndrome in this case. Over the one-year observation period, a sufficient hemodynamic improvement was obtained, without exacerbation of the PA dilatation, resulting in the absence of compression of the LMCA.

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“…Coronary artery stenosis is usually atherosclerotic, but on rare occasions, extrinsic compression of the LMCA is caused by a dilated MPA (left coronary artery compression syndrome). 2 Pina and colleagues 3 studied various risk factors for dilated MPA causing LMCA compression, such as LMCA originating from the right sinus of Valsalva, young women of short stature, large MPA (>40 mm, normal 25-30 mm), MPA trunk/ aorta ratio >1.2 (normal 1.0), LMCA angle of takeoff from the left sinus of Valsalva <30 . They also assessed the impact of intravascular ultrasound and fractional flow reserve in guiding the treatment of LMCA disease, and recommended revascularization if the intravascular ultrasound minimum lumen area is <5.9 mm and/or abnormal fractional flow reserve is <0.80.…”

Section: Discussionmentioning

confidence: 99%

Atrial septal defect causing angina

Bansal

Banday

Gupta

et al. 2019

Asian Cardiovasc Thorac Ann

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Left coronary artery compression syndrome is characterized by compression of the left main coronary artery between the aorta and an enlarged main pulmonary artery. A 39-year-old woman presented with angina with dyspnea on exertion for two years. Detailed investigations revealed an atrial septal defect, valvular lesions, and severe pulmonary hypertension with left main coronary artery compression. Patch closure of the atrial septal defect, left coronary artery bypass, and valve repair was carried out. The patient recovered well and was asymptomatic on follow-up. The optimal management of such patients is yet to be clarified.

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Extrinsic Compression of the Left Main Coronary Artery by Atrial Septal Defect

Cited by 14 publications

References 7 publications

Left main coronary artery compression by a left sinus of Valsalva aneurysm

Left main coronary artery compression by a left sinus of Valsalva aneurysm

Percutaneous Coronary Intervention for Left Main Compression Syndrome due to Severe Idiopathic Pulmonary Arterial Hypertension: One Year Follow-up Using Intravascular Imaging

Atrial septal defect causing angina

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