PP.22.07

Abstract

Objective: The left main coronary artery compression syndrome secondary to pulmonary artery trunk dilatation is a syndrome that is associated with severe pulmonary artery hypertension. Though the syndrome is known for quite a long time, the appropriate diagnostic and treatment approaches still remain poorly defined. Recently stenting of left main coronary artery became available for these patients as a new treatment strategy, though its implementation is still debatable. The definition of indications for endovascular treatment in this group of patients is difficult. Here we present a new methodology that helps to form a stent placement indication in patients with left main coronary artery compression syndrome. Design and method: A 32-years-old female with idiopathic pulmonary hypertension came to the hospital with increased exertional dyspnea and appearance of chest pain. Via performed computed tomography left main coronary artery compression was diagnosed. We observed the extrinsic compression of left main coronary artery by enlarged pulmonary artery. Data obtained from coronary angiography confirmed 60% left main coronary artery stenosis that is hemodynamically significant. To determine indications for revascularization intravascular ultrasound of left main coronary artery was performed. Results: Computed tomography showed a marked enlargement of the main pulmonary artery trunk (4.7 cm) with compression of the ostial left main coronary artery lumen. During coronary angiography we observed significant ostial left main coronary artery 60% stenosis, otherwise coronary arteries were intact. To determine the significance of the stenosis intravascular ultrasound was performed. According to intravascular ultrasound results there were not indications for endovascular left main treatment. It revealed narrowed lumen of the left main coronary artery (lumen area 9 mm2), compared to normal middle and distal areas of the artery (lumen area 20 mm2). So, in this case in contrast with coronary angiogram intravascular ultrasound data haven’t shown hemodynamically significant compression of left main coronary artery and conservative treatment was elected. Pulmonary hypertension specific therapy (Sildenafil) was initiated.Conclusions: We suggest that after computed tomography and coronary angiography intravascular ultrasound can be an addition method in determination of indications for endovascular treatment in patients with left main compression syndrome.