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Left main coronary trunk compression by dilated main pulmonary artery in atrial septal defect. Report of three cases
K Fujiwara1, Y Naito, S Higashiue
1Department of Thoracic and Cardiovascular Surgery, Wakayama Medical College, Japan.
Insights
Dilated pulmonary arteries can compress the left main coronary trunk, causing narrowing. Closing an atrial septal defect can resolve this coronary artery compression.
Area of Science:
- Cardiology
- Thoracic Surgery
Background:
- Atrial septal defect (ASD) is a congenital heart condition.
- Pulmonary hypertension can lead to pulmonary artery dilation.
Observation:
- Three adults with ASD presented with left main coronary trunk narrowing.
- The narrowing was attributed to compression by a dilated pulmonary artery.
- One patient had severe pulmonary hypertension.
Findings:
- Coronary angiograms showed localized, concave narrowing of the left main coronary trunk.
- Surgical closure of the ASD with a polytetrafluoroethylene patch was performed in all patients.
- Aorta-coronary bypass was done for 75% narrowing; not for 50% narrowing.
- Postoperative angiograms revealed improvement or resolution of left main coronary trunk narrowing in two patients.
Implications:
- Markedly dilated pulmonary arteries can compress and narrow the left main coronary trunk.
- Atrial septal defect closure can effectively treat this type of coronary artery compression.
- This highlights a potential mechanism for coronary artery compromise in patients with ASD and pulmonary hypertension.
Abstract:
Narrowing of the left main coronary trunk, which was compressed by the dilated pulmonary artery, was associated with atrial septal defect in three adults. One of them had severe pulmonary hypertension. Coronary angiograms revealed localized narrowing of the left main coronary trunk, and the left main coronary trunk had a concave shape. No stenosis of other coronary arteries was observed. In all patients the atrial septal defect was closed with a polytetrafluoroethylene patch. In the patient with 75% narrowing of the left main coronary trunk, aorta-coronary bypass was performed; it was not performed in the two with 50% narrowing. In two survivors postoperative coronary angiograms showed that the narrowing of the left main coronary trunk improved or disappeared. These results suggest that markedly dilated pulmonary arteries easily compress the left main coronary trunk and cause narrowing, which improves after atrial septal defect closure.