Coronary Artery Disease
Left main coronary artery compression from pulmonary artery enlargement due to pulmonary hypertension: A contemporary review and argument for percutaneous revascularization†
Michael S. Lee MD,
Jared Oyama MD,
Ravi Bhatia MD,
Young-Hak Kim MD,
Seung-Jung Park MD,
Corresponding Author
Michael S. Lee MD
Division of Cardiology, David Geffen School of Medicine at University of California, Los Angeles, California
UCLA Medical Center, Adult Cardiac Catheterization Laboratory, 10833 Le Conte Avenue, Rm BL-394 CHS, Los Angeles, CA 90095-171715Search for more papers by this authorJared Oyama MD
Division of Cardiology, David Geffen School of Medicine at University of California, Los Angeles, California
Search for more papers by this authorRavi Bhatia MD
Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania
Search for more papers by this authorYoung-Hak Kim MD
Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
Search for more papers by this authorSeung-Jung Park MD
Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
Search for more papers by this authorMichael S. Lee MD,
Jared Oyama MD,
Ravi Bhatia MD,
Young-Hak Kim MD,
Seung-Jung Park MD,
Corresponding Author
Michael S. Lee MD
Division of Cardiology, David Geffen School of Medicine at University of California, Los Angeles, California
UCLA Medical Center, Adult Cardiac Catheterization Laboratory, 10833 Le Conte Avenue, Rm BL-394 CHS, Los Angeles, CA 90095-171715Search for more papers by this authorJared Oyama MD
Division of Cardiology, David Geffen School of Medicine at University of California, Los Angeles, California
Search for more papers by this authorRavi Bhatia MD
Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania
Search for more papers by this authorYoung-Hak Kim MD
Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
Search for more papers by this authorSeung-Jung Park MD
Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
Search for more papers by this author†
Conflict of interest: Michael S. Lee: Speaker's bureau-Schering-Plough, BSCI, BMS, Daiichi Sankyo; Seung-Jung Park: Consulting fees from Cordis, lecture fees from Cordis, Medtronic, and Boston Scientific, and research grant support from Cordis and Medtronic; Young-Hak Kim: Lecture fees from Cordis.
Abstract
Extrinsic compression of the left main coronary artery by an enlarged pulmonary artery is an increasingly recognized and potentially reversible cause of angina and left ventricular dysfunction in patients with pulmonary hypertension. The diagnosis of extrinsic left main coronary artery compression requires a high index of suspicion and should be considered in patients with severe pulmonary hypertension who experience angina. Coronary angiography with intravascular ultrasound is the gold standard for diagnosis of this condition, though cardiac computed tomography and magnetic resonance angiography allow for noninvasive means of screening. The optimal treatment is debatable, but percutaneous coronary intervention appears to be a feasible, safe, and effective treatment option for patients with extrinsic compression of the left main coronary artery from pulmonary artery enlargement. Given the high risk of postoperative right ventricular failure and mortality observed with surgical revascularization in these patients, we recommend that physicians recognize percutaneous coronary intervention as the preferred revascularization strategy for selected patients with extrinsic compression of the left main coronary artery due to pulmonary hypertension. © 2010 Wiley-Liss, Inc.
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