Abstract

Compression of the left main coronary artery (LMCA) is increasingly recognised as a cause of angina, myocardial infarction and sudden death in patients with pulmonary hypertension [[1]Gailé N. Saia F. Pallazini M. et al.Left Main Coronary Artery Compression in Patients With Pulmonary Arterial Hypertension and Angina.JACC. 2017; 69: 2808-28017Crossref Scopus (70) Google Scholar,[2]Demerouti E.A. Manginas A.N. Athanassoupoulos G.D. et al.Complications leading to sudden cardiac death in pulmonary artery hypertension.Resp Care. 2013; 58: 1246-1254Crossref PubMed Scopus (50) Google Scholar]. Here we report a case of myocardial infarction with severe left ventricular dysfunction due to LMCA compression in a patient with Eisenmenger’s Syndrome. A 63-year-old female with Eisenmenger’s Syndrome due to a ventricular septal defect (VSD) and patent ductus arteriosus (PDA) presented with increasing dyspnoea over several weeks. Echocardiography illustrated severe global left ventricular systolic dysfunction (EF 17%), an unrestricted 12mm VSD, dilated and hypertrophied right ventricle with moderate tricuspid and pulmonary regurgitation. Estimated RV systolic pressure was 112mmHg. An ECG was revealed ST-elevation in aVR with widespread ST depression, with an elevated serum troponin of 6.7ug/L (<0.04). The patient had normal coronary angiography 2 years prior. Repeat coronary angiography revealed severe ostial LMCA stenosis due to extrinsic pulmonary artery compression, with the remaining vessels disease free. Percutaneous intervention to the LMCA was performed with a zotarolimus drug eluting stent with excellent angiographic result. Anti-platelets and up-titration of heart failure therapy was initiated. 2 years after discharge, she remains stable with a LVEF of 40% and NHYA Class II symptoms at home with her husband. In patients with pulmonary hypertension, progressive symptoms are often attributed to worsening pulmonary resistance or right heart dysfunction/ischaemia [[1]Gailé N. Saia F. Pallazini M. et al.Left Main Coronary Artery Compression in Patients With Pulmonary Arterial Hypertension and Angina.JACC. 2017; 69: 2808-28017Crossref Scopus (70) Google Scholar,[3]Gómez A. Bialostozky D. Zajarias A. et al.Right ventricular ischaemia in patients with primary pulmonary hypertension.JACC. 2001; 38: 1137-1142Crossref Scopus (179) Google Scholar]. LMCA compression represents an important and treatable cause of myocardial infarction and LV dysfunction with excellent medium-term outcomes.

Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call