Compression Of Coronary Artery Research Articles

Coronary artery compression by dilated pulmonary artery in an early infantile case of tetralogy of Fallot with absent pulmonary valve: ventricular fibrillation as the initial symptom of myocardial ischaemia.

Coronary artery compression by a dilated pulmonary artery is a rare complication in patients with tetralogy of Fallot with absent pulmonary valve. We present a case in which this condition manifested at two months of age, with ventricular fibrillation as the initial symptom of myocardial ischaemia. It is important to recognise that this potentially fatal complication can occur in early infancy.

A Tale of Grumpy Neighbours: Angina from Left Main Coronary Artery Compression in Severe Pulmonary Hypertension with Large ASD

This report presents a case of a 42-year-old patient diagnosed with ostium secundum atrial septal defect (ASD) with severe pulmonary arterial hypertension (PAH). The patient presented with progressive chest pain and dyspnea and was found to have a lesion in the left main coronary artery (LMCA) ostium by coronary angiography. Computed tomography (CT) imaging revealed a significant enlargement of the main pulmonary artery (MPA), which indicated possible compression of the LMCA by the pulmonary artery which was subsequently confirmed by coronary angiography and intravascular ultrasound (IVUS). Our patient underwent IVUS guided percutaneous coronary intervention by which a stent was deployed in the ostial LMCA, leading to near resolution of the patient's symptoms. Currently, the patient is under follow-up. This case highlights an often-overlooked cause of chest pain and dyspnea in patients with PAH. Although these patients often experience typical and atypical angina due to elevated right-sided pressures, the current report reveals that external compression of the LMCA by an enlarged pulomonarya artery(PA) can also cause coronary ischemia. Physicians should consider LMCA compression when assessing PAH patients with chest pain, as percutaneous coronary intervention and stenting can safely and effectively manage this condition.

Prognostic Implications of Resistive Reserve Ratio in Patients With Nonobstructive Coronary Artery Disease With Myocardial Bridging.

Myocardial bridging (MB) is accompanied by the dynamic extravascular compression of epicardial coronary arteries, leading to intracoronary hemodynamic disturbance with abnormal coronary flow profiles. We aimed to evaluate the prognostic implications of resistive reserve ratio (RRR), a composite measure of flow and pressure parameters that represents the vasodilatory capacity of the coronary arteries, in patients with angina with nonobstructive coronary artery disease (ANOCA) and MB, in comparison with coronary flow reserve (CFR). In this retrospective cohort study, we included patients with ANOCA who underwent coronary reactivity testing, where MB was identified by transient constriction in coronary artery segments between systole and diastole. Abnormal CFR and RRR were defined as <2.5 and <2.62, respectively. Major adverse cardiac events, including cardiovascular death, stroke, myocardial infarction, heart failure, and late revascularization, served as outcomes. Among 1251 patients with ANOCA, 191 (15.3%) had MB. The prevalence of abnormal CFR or RRR was not significantly different between patients with and without MB (P=0.144 and P=0.398, respectively). Over a median follow-up time of 6.9 years, abnormal RRR predicted major adverse cardiac events in patients with MB (hazard ratio [HR], 4.38 [95% CI, 1.71-11.21]; P=0.002) and without MB (HR, 1.91 [95% CI, 1.38-2.64]; P<0.001). Abnormal CFR predicted major adverse cardiac events in patients without MB (HR, 2.15 [95% CI, 1.54-3.00]; P<0.001), whereas it was not predictive of major adverse cardiac events in patients with MB (HR, 2.29 [95% CI, 0.93-5.65]; P=0.073). In patients with ANOCA and MB, impaired RRR was superior to impaired CFR in distinguishing patients at a higher risk of future adverse events, suggesting that RRR may serve as a risk stratification tool in patients with MB and ANOCA.

Transcatheter pulmonary valve replacement after arterial switch operation.

Patients with d-transposition of the great arteries (d-TGA) who have undergone an arterial switch operation (ASO) can develop right ventricular outflow tract (RVOT) dysfunction with pulmonary regurgitation (PR) or stenosis. In these patients, treatment may include transcatheter pulmonary valve replacement (TPVR). Coronary compression is a contraindication occurring in 5% of typical TPVR cases. After ASO, there are various anatomical considerations that can confound TPVR, including potential coronary artery compression. Our goal is to understand feasibility of TPVR in patients following ASO. This was a retrospective multicenter cohort study of patients with RVOT dysfunction after ASO who underwent cardiac catheterization with intention to perform TPVR from 2008 to 2020. Across nine centers, 33 patients met inclusion criteria. TPVR was successful in 22 patients (66%), 19 receiving a Melody valve and 3 a SAPIEN valve. RVOT stenosis in isolation or with PR dictated need for TPVR in nearly all patients. One serious adverse event occurred with valve embolization. After TPVR, the RVOT peak gradient decreased from 43 to 9 mm Hg (p < 0.001); PR was trivial/none in all but one patient, in whom it was mild. Coronary compression prohibiting TPVR occurred in eight patients (24%) and two patients (6%) had severe aortic regurgitation from aortic root deformation precluding TPVR. Seven patients underwent RVOT reintervention with a median of 5.3 years post-TPVR. TPVR in patients with d-TGA after ASO is feasible, but in this cohort, coronary compression or aortic root distortion precluded TPVR in one-third of patients. The rate of RVOT reintervention after TPVR was higher in this cohort of ASO patients that in prior studies.

Primary cardiac lymphoma causing coronary artery compression and massive tricuspid regurgitation.

Primary cardiac lymphoma causing coronary artery compression and massive tricuspid regurgitation.

Epicardial pacing outcomes in infants with heart block: Lead and device complications from a multicenter experience

BackgroundInfants with complete heart block (CHB) require epicardial pacemaker (PM) insertion. Prior studies described epicardial pacing outcomes in infants and children, although they were limited by small or heterogeneous populations. ObjectiveThis study aimed to explore patient- and procedure-level associations with device complications in infants with CHB who received a permanent PM. MethodsThis was a multicenter, retrospective cohort study including infants receiving an epicardial PM between 2000 and 2021 for CHB. The primary outcome was time to device-related adverse event: lead failure requiring revision; pocket infection; exit block requiring increased pacing output; or lead-related coronary artery compression. Time-to-event analysis was performed by the Kaplan-Meier method with a multivariable Cox proportional hazards model. ResultsThere were 174 infants who received an epicardial PM (282 bipolar, 39 unipolar leads) for CHB. Median age and weight at PM were 93.5 days and 4.5 kg, respectively. Pacing indication was postoperative CHB in 63% and congenital CHB in 37%. The median follow-up was 2.1 years. The primary outcome occurred in 26 infants at a median time to event of 0.6 year. Age ≤90 days at PM implantation was the most significant risk factor for a device-related adverse event (hazard ratio, 7.02; P < .001), primarily driven by pocket infections. Lead failure occurred in 3% of leads with a 5- and 10-year freedom from failure of 93% and 83%, respectively. ConclusionDevice complications affect 15% of infants receiving a permanent PM for heart block. Age ≤90 days at PM implantation is especially associated with infectious complications. Epicardial lead durability appears similar to previously reported pediatric experiences.

Surgical Repair of Giant Dissecting Pulmonary Artery Aneurysm Associated with Atrial Septal Defect and Pulmonary Arterial Hypertension: A Case Report

Pulmonary artery aneurysm (PAA) and pulmonary artery dissection (PAD) are rare and potentially fatal conditions that may lead to pulmonary artery (PA) rupture and cardiac tamponade. PAA is often associated with other cardiac and congenital heart diseases, such as atrial septal defect (ASD). We report a case of a patient with ASD and a giant dissecting PAA who underwent surgical repair to prevent potentially fatal outcome and discuss the probable etiologies of this case. We present a rare case of a 50-year-old woman with a secundum ASD and severe pulmonary arterial hypertension (PAH) who developed a giant PAA of 114 mm with dissection. The PAA caused extrinsic compression of the left main coronary artery (LMCA), which was misdiagnosed as coronary artery disease (CAD) at local hospital. Right heart catheterization revealed PAH of 73 mmHg and she was referred to our center for further treatment. After 4 months of lowering PAH treatment, she underwent successful surgical repair of the PAA to release the compression of LMCA, as well as mechanical valve replacement, fenestrated ASD closure and tricuspid valvuloplasty. She had an uneventful recovery and showed significant improvement in pulmonary hemodynamics and clinical symptoms at one-year follow-up. PAA with dissection is a rare complication of ASD and PAH that can potentially be fatal. Patients with large or symptomatic PAA and PAD may require early surgical intervention, particularly if they experience compression of nearby structures or are at risk of rupture. It is crucial to promptly refer and consult with specialists and ensure optimal preoperative hemodynamic management to enhance patient outcomes.

Risk Factors for Coronary Artery Complications After Prosthetic Pulmonary Valve Implantation in Patients With Congenital Heart Disease.

Coronary artery complications (CACs) in patients who undergoing prosthetic pulmonary valve implantation for congenital heart disease can lead to fetal outcomes. However, the incidence of and risk factors for CACs in these patients remain unknown. A retrospective cohort study was conducted on patients who underwent cardiac computed tomography or invasive coronary angiography after prosthetic pulmonary valve implantation at Seoul National University Hospital from June 1986 to May 2021. Among 341 patients, 25 (7.3%) were identified with CACs, and 2 of them died. Among the patients with CACs, congenital coronary anomalies and an interarterial course of the coronary artery were identified in 11 (44%) and 18 (72%) patients, respectively. Interarterial and intramural courses of the coronary artery were associated with a 4.4- and 10.6-fold increased risk of CACs, respectively. Among patients with tetralogy of Fallot and pulmonary atresia, the aortic root was rotated further clockwise in patients with coronary artery compression compared to those without it (mean [±SD] 128.0±19.9° vs. 113.5±23.7°; P=0.024). The cut-off rotation angle of the aorta for predicting the occurrence of coronary artery compression was 133°. Perioperative coronary artery evaluation and prevention of CACs are required in patients undergoing prosthetic pulmonary valve implantation, particularly in those with coronary artery anomalies or severe clockwise rotation of the aortic root.

Finite element modeling with patient-specific geometry to assess clinical risks of percutaneous pulmonary valve implantation.

Percutaneous pulmonary valve implantation (PPVI) is a non-surgical treatment for right ventricular outflow tract (RVOT) dysfunction. During PPVI, a stented valve, delivered via catheter, replaces the dysfunctional pulmonary valve. Stent oversizing allows valve anchoring within the RVOT, but overexpansion can intrude on the surrounding structures. Potentially dangerous outcomes include aortic valve insufficiency (AVI) from aortic root (AR) distortion and myocardial ischemia from coronary artery (CA) compression. Currently, risks are evaluated via balloon angioplasty/sizing before stent deployment. Patient-specific finite element (FE) analysis frameworks can improve pre-procedural risk assessment, but current methods require hundreds of hours of high-performance computation. We created a simplified method to simulate the procedure using patient-specific FE models for accurate, efficient pre-procedural PPVI (using balloon expandable valves) risk assessment. The methodology was tested by retrospectively evaluating the clinical outcome of 12 PPVI candidates. Of 12 patients (median age 14.5 years) with dysfunctional RVOT, 7 had native RVOT and 5 had RV-PA conduits. Seven patients had undergone successful RVOT stent/valve placement, three had significant AVI on balloon testing, one had left CA compression, and one had both AVI and left CA compression. A model-calculated change of more than 20% in lumen diameter of the AR or coronary arteries correctly predicted aortic valve sufficiency and/or CA compression in all the patients. Agreement between FE results and clinical outcomes is excellent. Additionally, these models run in 2-6 min on a desktop computer, demonstrating potential use of FE analysis for pre-procedural risk assessment of PPVI in a clinically relevant timeframe.

A Case Report: A Successful Management of Extrinsic Compression of the Left Main Coronary Artery by a Dilated Pulmonary Artery in Patients with Pulmonary Arterial Hypertension

Extrinsic compression of the left main coronary artery (LMCA) by a dilated pulmonary artery can be life threatening in pulmonary arterial hypertension patients; however, it can be treated with percutaneous coronary intervention. In this case report, we presented a successful treatment with the stenting of the LMCA stenosis associated with extrinsic compression of LMCA by a dilated pulmonary artery.

Left main coronary artery compression in precapillary pulmonary hypertension.

Pulmonary hypertension (PH) is a progressive and invalidating condition despite available therapy. Addressing complications such as left main coronary artery compression (LMCo) due to the dilated pulmonary artery (PA) may improve symptoms and survival. Nevertheless, clear recommendations are lacking. The aim of this study is to analyze the prevalence, characteristics, predictive factors and impact of LMCo in a heterogenous precapillary PH population in a single referral center. Two hundred sixty-five adults with various etiologies of precapillary PH at catheterization were reviewed. Coronary angiography (CA) was performed for LMCo suspicion. Revascularization was performed in selected cases. Outcomes were assessed at a mean follow-up of 3.9 years. LMCo was suspected in 125 patients and confirmed in 39 (31.2%), of whom 21 (16.8%) had 50%-90% stenoses. Nine revascularizations were performed, with clinical improvement. The only periprocedural complication was a stent migration. LMCo was associated with PH etiology (p 0.003), occuring more frequently in congenital heart disease-associated PH (61.5% of all LMCo cases, 66.6% of LMCo ≥ 50%). Predictors of LMCo ≥50% were PA ≥ 37.5 mm (Sn 81%, Sp 74%) and PA-to-aorta ≥1.24 (Sn 81%, Sp 69%), with increased discrimination when considering RV end-diastolic area. LMCo ≥ 50% without revascularization presented clinical deterioration and worse survival (p 0.019). This analysis of a heterogeneous pre-capillary PH population provides LMCo prevalence estimation, predictive factors (PA size, PA-to-aorta, RV end-diastolic area and PH etiology) and long-term impact. While LMCo impact on survival is inconclusive, untreated LMCo ≥ 50% has worse prognosis. LMCo revascularization may be performed safely and with good outcomes.

Percutaneous pulmonary valve implantation in a patient with congenitally corrected transposition of the great arteries: a case report

BackgroundPercutaneous pulmonary valve implantation has become an attractive method of dysfunctional right ventricle outflow tract treatment.Case presentationWe describe a unique case of a 20-year-old Caucasian male patient with a complex cyanotic heart defect, namely pulmonary atresia, with congenitally corrected transposition of the great arteries and ventricular septal defect after Rastelli-like surgery at the age of 5 years with homograft use. At the age of 20 years, the patient needed percutaneous pulmonary valve implantation owing to homograft dysfunction. Despite unusual course of the coronary arteries, balloon testing in the landing zone of the right ventricle outflow tract excluded potential coronary artery compression. Then, after presentation, a Melody valve was implanted successfully in the pulmonary valve position. The 8-year follow-up was uneventful.ConclusionThis is likely the first description of a percutaneous pulmonary valve implantation in such anatomy. Such a procedure is feasible; however, it requires exceptional caution owing to the anomalous coronary arteries course, which can be the reason for their compression.

ДИФФУЗНОЕ АЛЬВЕОЛЯРНОЕ ПОВРЕЖДЕНИЕ ЛЕГКИХ ПРИ COVID-19 В СОЧЕТАНИИ С ДИФФУЗНОЙ В-КРУПНОКЛЕТОЧНОЙ ЛИМФОМОЙ И ИНФАРКТОМ МИОКАРДА. КЛИНИКО-МОРФОЛОГИЧЕСКОЕ НАБЛЮДЕНИЕ

In this article, we report a case of the combination of COVID-19 with diffuse alveolar lung injury and diffuse large B-cell lymphoma with coronary artery compression by tumor nodules in the epicardium, resulting in myocardial infarction and subsequent fatal outcome. The article reviews the complex interaction between COVID-19 and oncological diseases, demonstrating how the coronavirus infection can significantly exacerbate the progression of malignant neoplasms through different mechanisms.

Eisenmenger syndrome complicated by the presence of an aneurysm of the pulmonary trunk and compression of the left main coronary artery.

Eisenmenger syndrome complicated by the presence of an aneurysm of the pulmonary trunk and compression of the left main coronary artery.

Intentional Bioprosthetic Valve Ring Fracture Causing Coronary Artery Compression During Transcatheter Pulmonary Valve Replacement

Intentional Bioprosthetic Valve Ring Fracture Causing Coronary Artery Compression During Transcatheter Pulmonary Valve Replacement

Risk factors for coronary artery complications after prosthetic pulmonary valve implantation in congenital heart diseases

Abstract Background The incidence and risk factors for coronary artery complications in patients who underwent pulmonary valve replacement or valved conduit interposition for congenital heart diseases were unknown. Purpose This study was an extension of the previous study† to investigate the incidence and risk factors of coronary artery complications among patients who underwent prosthetic pulmonary valve implantation. Methods Retrospective cohort study was performed for the patients who underwent cardiac CT or invasive coronary angiography after the prosthetic pulmonary valve implantation at the tertiary referral hospital from June 1986 to May 2021. The rotation angle of the aorta and angles of both coronary artery orifices were measured on a Picture Archiving and Communication System (Figure 1). The Cox regression analysis was used to identify variables predicting the occurrence of coronary artery complications. Survival rates were assessed by Kaplan-Meier analysis. Results Coronary artery complications were identified in 25 patients among the 341 patients (7.3%), and two of them died. The median age at diagnosis of coronary artery complications was 20 years (interquartile range: 12.5-25 years). The coronary artery complication-free survival rate was predicted to be 97.3% at 5 years, 92.5% at 10 years, 85.5% at 20 years, and 61.1% at 30 years. The risk of cardiac death was 1.865 times higher [95% CI: 0.403, 8.628] in patients with coronary artery complications than in those without it; nevertheless, the difference was not statistically significant (p-value = 0.425). Among the patients with coronary artery complications, congenital coronary anomalies were identified in 11 (44 %), interarterial course of coronary artery in 18 (72 %), and intramural course in 4 patients (16%). Interarterial course and intramural course of the coronary artery were associated with a 4.4 and 10.6-fold increased risk of coronary artery complications, respectively. When subgroup analysis was performed in patients with tetralogy of Fallot and pulmonary atresia, the aortic root rotated more clockwise in patients with coronary artery compression than in patients without it (128.0°± 19.9° versus 113.5°± 23.7°, p-value = 0.024). The cut-off value of the rotation angle to predict the occurrence of coronary artery compression was 133˚ (Figure 2). Conclusion Preoperative and postoperative long-term coronary assessment should be performed in patients with conotruncal anomalies undergoing prosthetic pulmonary valve implantation, especially in those with abnormal courses of coronary arteries or severe rotation of aortic root. The rotation angle of aorta could be measured on cardiac CT angiography prior to surgery, and the location of the prosthetic valve or conduit should be carefully determined.Measurement of anglesKaplan-Meier curves

Pulmonary artery aneurysm in pulmonary arterial hypertension associated with congenital heart disease

Abstract Introduction Pulmonary artery aneurysms are a common finding in patients with congenital heart disease, often asymptomatic and with a described low complication rate. The aim of this study is to assess the prevalence of PAA in a population with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) and associated complications. Methods All adult patients with PAH-CHD at our institution with angiography of the pulmonary tree by computed tomography (CT) or magnetic resonance imaging (MRI) were included in a retrospective analysis. PAA was defined as a main PA diameter &amp;gt; 40 mm. Results In this study, the frequency of PAA was as high as 76%. Simple pre-tricuspid lesions had larger diameters than post-tricuspid lesions (p=0.004), but there were no significant differences with complex lesions. Also, no differences were found between the median diameters of the different PAH-CHD groups. No relationship was seen between the development of aneurysms or larger diameters and haemodynamic severity, even a majority of patients had severe pulmonary arterial hypertension. 15 patients (25% of total with PAA) had complications related to PAA: 4 patients with PA dissection (isolated or with associated thrombosis), 7 patients with chronic pulmonary thrombosis and 5 patients with left main coronary artery compression (figure 2). There were no complications in patients with diameters less than 40 mm. During a median follow-up of 3.8 years (IQR 1.6 to 6.4 years) 24 patients (30%) died or needed lung/cardiopulmonary transplantation (17 and 7 respectively). Only two (8.3%) of the patients with final events did not have PAA. Survival analysis (figure 1) showed a higher rate of death or need for transplantation in patients with pulmonary artery aneurysm, especially if there was an added complication (log-rank test, P=0.017). Conclusions Pulmonary artery aneurysms in patients with pulmonary arterial hypertension associated with congenital heart disease are common. The rate of related complications is also high in this population and may have prognostic implications.Survival analysisComplications related to PA

Abstract 11597: A Rare Cause of an NSTEMI: Left Main Coronary Artery Compression in a Patient With Pulmonary Hypertension

Background: Pulmonary hypertension has varying effects on cardiac function. Though uncommon, a dilated pulmonary artery can cause decreased coronary perfusion through extrinsic compression of the left main coronary artery (LMCA). While the most common presentation of LMCA compression is angina, acute coronary syndrome is rare. Case Summary: An 81-year-old female with a history of group 3 pulmonary hypertension presenting with neck and shoulder pain was found to have elevated cardiac biomarkers and EKG findings remarkable for isolated ST elevation in aVR with diffuse ST depressions in all other leads, consistent with a non-ST elevation myocardial infarction. Coronary angiography revealed left main coronary artery compression that was successfully intervened on with placement of a single drug eluding stent. Right heart catheterization was remarkable for evidence of severe pulmonary hypertension with a mean pulmonary artery pressure of 60 mmHg. Discussion: Given the patient’s past medical history, presenting symptoms, coronary and right heart catheterization findings the etiology of her acute coronary syndrome presentation was thought to be driven by left main coronary artery compression from pulmonary artery dilation. Pulmonary artery dilation in individuals with a history of pulmonary hypertension is common, with several modalities available to evaluate for this anatomic compensatory measure. Management for left main coronary artery compression in this patient population is percutaneous coronary intervention. Future studies to determine if routine screening for coronary compression in patients with pulmonary hypertension is needed.

Histopathology of resected tissue from repair of anomalous aortic origin of a coronary artery: Potential mechanism of coronary artery compression

ObjectiveThis study aimed to describe the histomorphologic characteristics of resected (unroofed) common wall tissue from repair of anomalous aortic origin of a coronary artery and to determine whether the histologic features correlate with clinical and imaging findings. MethodsThe histology of resected tissue was analyzed and reviewed for the presence of fibrointimal hyperplasia, smooth muscle disarray, mucoid extracellular matrix accumulation, mural fibrosis, and elastic fiber disorganization and fragmentation using hematoxylin and eosin and special stains. Clinical, computed tomography imaging, and surgical data were correlated with the histopathologic findings. ResultsTwenty specimens from 20 patients (age range, 7-18 years; 14 males) were analyzed. Anomalous aortic origin of a coronary artery involved the right coronary in 16 (80%), and a slit-like ostium was noted in 18 (90%). By computed tomography imaging, the median proximal coronary artery eccentricity index was 0.4 (range, 0.20-0.90). The median length of intramural course was 8.2 mm (range, 2.6-15.2 mm). The anomalous vessel was determined to be interarterial in 14 patients (93%, 15 had evaluable images). The median distance from a commissure was 2.5 mm above the sinotubular junction (STJ) (range: 2 mm below the STJ–14 mm above the STJ). Prominent histopathologic findings included elastic fiber alterations, mural fibrosis, and smooth muscle disarray. The shared wall of the aorta and intramural coronary artery is more similar to the aorta histologically. Mural fibrosis and elastic fiber abnormalities tended to be more severe in patients >10 years of age at the time of surgery, but this did not reach statistical significance. The extent of vascular changes did not appear to have a clear relationship with the imaging features. ConclusionsThe findings confirm the aortic wall–like quality of the intramural segment of the coronary artery and the presence of pathologic alterations in the wall microstructure.

Large Pulmonary Embolism With Paradoxical Embolism to a Coronary Artery Presenting as Inferior ST Elevation Myocardial Infarction, With Concomitant Compression of the Left Main Coronary Artery by a Dilated Main Pulmonary Artery

Large Pulmonary Embolism With Paradoxical Embolism to a Coronary Artery Presenting as Inferior ST Elevation Myocardial Infarction, With Concomitant Compression of the Left Main Coronary Artery by a Dilated Main Pulmonary Artery