Sivakumar Kothandam, Rajan Maruthanayagam, Francis Gnanapragasam, Murali Krishnaswami, Bashi Velayudhan
Department of Cardiology, MIOT Hospital, Manapakkam, Chennai 600089, India.
Tex Heart Inst J. 2010;37(1):95-8.
Extrinsic compression of the left main coronary artery by a massively dilated pulmonary artery in patients who have severe pulmonary hypertension can lead to significant myocardial ischemia. A 58-year-old man with a large patent ductus arteriosus and Eisenmenger syndrome presented with angina at rest and worsening heart failure of 3 months' duration. The new symptoms were recognized to be secondary to extrinsic compression of the left main coronary artery ostium by a dilated main pulmonary artery and were successfully relieved by the placement of a metallic stent in the affected segment of the left main coronary artery. Multislice computed tomographic imaging after 6 months showed stent patency and the intimate relation of the stented vessel to the dilated main pulmonary trunk. We discuss diagnostic and management issues pertaining to this uncommon clinical entity.
重度肺动脉高压患者中，扩张的肺动脉对左主干冠状动脉的外在压迫可导致严重心肌缺血。一名58岁患有大型动脉导管未闭和艾森曼格综合征的男性，出现静息性心绞痛和持续3个月的心力衰竭加重。新症状被认为是扩张的主肺动脉对外侧左主干冠状动脉口外在压迫所致，通过在左主干冠状动脉受累节段置入金属支架得以成功缓解。6个月后的多层计算机断层成像显示支架通畅，且支架置入血管与扩张的主肺动脉干关系密切。我们讨论了与这一罕见临床实体相关的诊断和管理问题。
