Albadri Kadhem, Jensen Jesper M, Christiansen Evald H, Mellemkjær Søren, Nielsen-Kudsk Jens Erik
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Pulm Circ. 2015 Dec;5(4):734-6. doi: 10.1086/683690.
In patients with pulmonary arterial hypertension (PAH), chest pain is most likely due to right ventricular demand ischemia. We report a patient with idiopathic PAH who developed severe angina due to extrinsic compression of the left main coronary artery (LMCA) from a dilated pulmonary artery trunk. The diagnosis was verified by electrocardiogram after exercise, coronary angiography including intravascular ultrasound, and cardiac multidetector computed tomography (MDCT). The origin of the LMCA was high in the left coronary sinus, facilitating extrinsic compression. The patient was successfully treated by percutaneous coronary intervention with stent implantation in the LMCA. Extrinsic compression of the LMCA is a severe and potentially fatal complication that should be considered in all patients with PAH and angina. MDCT is the method of choice for first-line diagnosis.
在肺动脉高压（PAH）患者中，胸痛最可能是由于右心室需求性缺血所致。我们报告了一名特发性PAH患者，该患者因扩张的肺动脉主干对左主干冠状动脉（LMCA）的外在压迫而发生严重心绞痛。运动后心电图、包括血管内超声的冠状动脉造影以及心脏多排螺旋计算机断层扫描（MDCT）均证实了该诊断。LMCA起源于左冠状窦高位，易发生外在压迫。该患者通过在LMCA植入支架的经皮冠状动脉介入治疗获得成功。LMCA的外在压迫是一种严重且可能致命的并发症，所有PAH和心绞痛患者均应考虑到这一点。MDCT是一线诊断的首选方法。
