Left main coronary artery compression due to dilatation of the main pulmonary artery in patients with pulmonary hypertension: treatment and long-term follow-up

Abstract

Compresión del tronco de la arteria coronaria izquierda por la dilatación de la arteria pulmonar principal en pacientes con hipertensión pulmonar: tratamiento y seguimiento a largo plazo

Technical Recommendations for Computed Tomography Guidance of Intervention in the Right Ventricular Outflow Tract: Native RVOT, Conduits, and Bioprosthetic Valves

“…This is best imaged with aorta in short axis and pulmonary artery in long axis with the potential landing zone visualized. There is a higher risk of coronary compression if the coronary artery runs between the aorta and the PA at the level of the proposed landing zone. Underlying diagnosis of conotruncal abnormality: This is associated with clockwise rotation of the coronary arteries placing the origin between the aorta and PA, even when arising from the appropriate aortic sinus. High origin of the coronary artery from the sinus of Valsalva or above, running posterior and below the conduit and landing zone. Coronary artery course adjacent to or just posterior to the landing zone, particularly if acute angulation from the aortic root. Coronary artery distance < 3mm from the RVOT landing zone, <8 mm from the sternum. Loss of intervening fat between the coronary and RVOT conduit. Coronary artery near areas of calcification and scar tissue, where conduit rupture is higher risk. Pulmonary hypertension (highest risk when the PA diameter is >4 cm or the PA/AO diameter ratio is >1.2) 100,106,107 …”

“…Pulmonary hypertension is common in ACHD patients and is an independent risk factor for coronary compromise in a dilated RVOT. 100 , 101 …”

“… Coronary artery near areas of calcification and scar tissue, where conduit rupture is higher risk. Pulmonary hypertension (highest risk when the PA diameter is >4 cm or the PA/AO diameter ratio is >1.2) 100 , 106 , 107 …”

“…Pulmonary hypertension (highest risk when the PA diameter is >4 cm or the PA/AO diameter ratio is >1.2) 100 , 106 , 107 …”