Division of Cardiology, University of California, Los Angeles, CA, USA.
Rev Cardiovasc Med. 2012;13(1):e32-6. doi: 10.3909/ricm0587.
Extrinsic compression due to pulmonary artery enlargement from severe pulmonary hypertension is an uncommon cause of hemodynamically significant left main artery stenosis. Patients with severe pulmonary hypertension who experience angina should be evaluated for possible extrinsic compression of the left main artery due to pulmonary artery enlargement. Although computed tomographic angiography and cardiac magnetic resonance imaging are helpful in the screening for extrinsic left main artery compression, coronary angiography is the gold standard for the diagnosis. Percutaneous coronary intervention of the left main artery is feasible, safe, and a reasonable initial revascularization strategy for these patients because of the high risk of postoperative right ventricular failure and mortality observed with bypass surgery.
肺动脉扩张引起的外在压迫是重度肺动脉高压导致血流动力学显著的左主干狭窄的不常见原因。重度肺动脉高压患者出现心绞痛时，应评估因肺动脉扩张导致左主干动脉外在压迫的可能性。尽管计算机断层血管造影和心脏磁共振成像有助于筛查外在性左主干动脉压迫，但冠状动脉造影是诊断的金标准。对于这些患者，经皮冠状动脉介入治疗左主干动脉是可行的、安全的，也是合理的初始血运重建策略，因为旁路手术后观察到右心室衰竭和死亡率较高。
