A case of left main systolic compression caused by a dilated pulmonary artery in a patient with congenital pulmonic stenosis.

Dynamic compression of the left main coronary artery during systole is extremely rare. We report a case of a 29-year old female who presented with shortness of breath and chest pain with exertion. She had a history of congenital pulmonic stenosis and had a pulmonary valve resection at age 2. She subsequently developed chronic pulmonic insufficiency. She had normal left ventricular systolic function and a dilated right ventricle with pressure and volume overload diagnosed by echocardiography. She had pulmonary artery hypertension with pulmonary artery pressures noted to be systolic of 62mmHg, diastolic of 10 mmHg, mean of 29 mmHg on right heart catheterization. Her echocardiogram also showed an elevated mean pulmonary artery pressure of 25 mmHg, which was thought to be due to increased flow. On left heart catheterization, she was found to have dynamic systolic compression of the left main coronary artery by a dilated pulmonary artery. This is the first case report of a patient with congenital pulmonic stenosis with a dilated pulmonary trunk causing systolic compression of the left main coronary artery. Dynamic systolic compression of the left main coronary artery is a rare cause of angina, is rarely reported, and requires a high level of suspicion and careful investigation for accurate diagnosis.