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经皮左主干冠状动脉受压于肺动脉瘤。

Percutaneous intervention of left main coronary artery compression by pulmonary artery aneurysm.

机构信息

Division of Cardiology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.

出版信息

Catheter Cardiovasc Interv. 2010 Sep 1;76(3):352-6. doi: 10.1002/ccd.22555.

Abstract

BACKGROUND

Extrinsic compression of the left main coronary artery (LMCA) by a pulmonary artery aneurysm (PAA) has become increasingly recognized as an etiology of angina in patients with pulmonary arterial hypertension (PAH). The purpose of this study was to assess the feasibility and efficacy of LMCA stenting in the treatment LMCA stenosis because of PAA.

METHODS

Retrospective analysis of data on patients with PAH who presented with angina and underwent percutaneous intervention of their LMCA compression because of PAA was performed.

RESULTS

Five patients (age 51 ± 16 years, all female) with PAH presented with angina and underwent LMCA stenting between 2007 and 2009. Four had positive cardiac enzymes. LMCA compression because of a PAA was diagnosed in all patients with cardiac CT angiography after echocardiography demonstrated an enlarged pulmonary artery. LMCA stenting was successfully performed in all patients with resolution of angina and electrocardiographic abnormalities. After a mean follow-up of 16.6 ± 15.7 months (range of 5-39 months), patients remained angina free, no complications of the procedure were noted, and long term stent patency was confirmed in three of the five patients who underwent repeat cardiac CT angiography.

CONCLUSIONS

LMCA stenting appears to be a feasible and durable option in patients who present with angina because of compression by PAA. This procedure was well tolerated and is of particular value given the increased surgical risk in patients with PAH.

摘要

背景

肺动脉瘤(PAA)对左主干冠状动脉(LMCA)的外在压迫,已被认为是肺动脉高压(PAH)患者心绞痛的一个病因。本研究旨在评估经皮介入治疗 PAA 所致 LMCA 狭窄的可行性和疗效。

方法

回顾性分析了 2007 年至 2009 年间因 PAA 导致 LMCA 受压而出现心绞痛并接受经皮介入治疗的 PAH 患者的数据。

结果

5 例 PAH 患者(年龄 51 ± 16 岁,均为女性)出现心绞痛,并接受 LMCA 支架置入术。4 例患者心肌酶谱阳性。心脏超声检查提示肺动脉增大后,行心脏 CT 血管造影检查,均诊断为 PAA 导致的 LMCA 受压。所有患者均成功完成 LMCA 支架置入术,心绞痛和心电图异常均得到缓解。平均随访 16.6 ± 15.7 个月(5-39 个月)后,患者无胸痛发作,无手术相关并发症,3 例重复行心脏 CT 血管造影检查的患者长期支架通畅。

结论

对于因 PAA 压迫而出现心绞痛的患者,LMCA 支架置入术似乎是一种可行且持久的选择。该手术耐受性良好,鉴于 PAH 患者手术风险增加,具有特殊价值。

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