Cabral Diogo Ribeiras, Guimarães Tatiana, Almeida Ana G, Campos Paula, Martins Susana R, da Silva Pedro Canas, Pinto Fausto J, Plácido Rui
Lisbon School of Medicine of the Universidade de Lisboa, Lisboa, Portugal.
Cardiology Department, Santa Maria University Hospital, Lisbon Academic Medical Centre, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Lisboa, Portugal.
Rev Port Cardiol. 2022 Jan;41(1):73-80. doi: 10.1016/j.repc.2020.05.021. Epub 2021 Sep 25.
Chest pain is a frequent symptom in patients with pulmonary arterial hypertension (PAH). Left main coronary artery (LMCA) extrinsic compression from a pulmonary artery (PA) is an increasingly recognized cause of angina or complications, such as acute myocardial infarction, left ventricular dysfunction, arrythmia, and sudden death. We report the case of a 45-year-old patient with pre-capillary pulmonary hypertension (PH), a patent ductus arteriosus corrected surgically during adolescence, and chronic constrictive bronchiolitis. In 2016, the patient began to report oppressive chest pain and worsening fatigue. Computed tomography coronary angiography (CTCA) showed extrinsic LMCA compression by a dilated PA, which was confirmed by invasive coronary angiography and intravascular ultrasound. After stent implantation, the patient reported symptom resolution, and has been asymptomatic ever since. Imaging studies, in particular CTCA, play an important role in the diagnosis of LMCA compression in patients with PAH. The reported case supports the efficacy and safety of stent implantation as a therapeutic option, as already demonstrated in the literature. It shows the complexity of decision making on the operability of systemic-to-pulmonary shunts and reinforces the importance of continuous diagnostic testing.
胸痛是肺动脉高压（PAH）患者的常见症状。肺动脉（PA）对左冠状动脉主干（LMCA）的外在压迫是心绞痛或并发症（如急性心肌梗死、左心室功能障碍、心律失常和猝死）的一个日益被认识到的原因。我们报告了一例45岁的患者，患有毛细血管前肺动脉高压（PH），青春期接受过动脉导管未闭手术矫正，并有慢性缩窄性细支气管炎。2016年，该患者开始出现压迫性胸痛和疲劳加重。计算机断层扫描冠状动脉造影（CTCA）显示扩张的PA对LMCA有外在压迫，这通过有创冠状动脉造影和血管内超声得到证实。支架植入术后，患者报告症状缓解，此后一直无症状。影像学检查，尤其是CTCA，在PAH患者LMCA压迫的诊断中起着重要作用。报道的病例支持了支架植入作为一种治疗选择的有效性和安全性，正如文献中已经证明的那样。它显示了关于体肺分流术可操作性决策的复杂性，并强化了持续诊断检测的重要性。
