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Extrinsic compression of the left main coronary artery by atrial septal defect

Yusuke Jo1, Akio Kawamura, Masahiro Jinzaki

  • 1Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.

The Annals of Thoracic Surgery
|November 22, 2008
PubMed

Insights

Extrinsic compression of the left main coronary artery by a dilated pulmonary trunk is rare. Surgical repair of atrial septal defect and coronary artery bypass resolved the coronary artery narrowing.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Medical Imaging

Background:

  • Extrinsic compression of coronary arteries, though rare, can lead to significant stenosis.
  • Atrial septal defect (ASD) is a congenital heart condition that can sometimes be associated with pulmonary hypertension and trunk dilation.

Observation:

  • A 42-year-old woman with an atrial septal defect presented with symptoms suggestive of coronary artery compromise.
  • Preoperative cardiac 64-slice multi-detector computed tomography (MDCT) revealed extrinsic compression of the proximal left main coronary artery due to marked dilatation of the pulmonary trunk.

Findings:

  • The patient underwent successful simultaneous surgical repair of the atrial septal defect and coronary artery bypass grafting.
  • Postoperative MDCT at four months showed a reduced pulmonary trunk diameter and complete resolution of the left main coronary artery stenosis.

Implications:

  • This case highlights the importance of considering extrinsic coronary artery compression in patients with pulmonary hypertension and congenital heart disease.
  • Simultaneous surgical intervention can effectively treat both the underlying cardiac defect and the resulting coronary artery compromise.
  • MDCT is a valuable tool for diagnosing and monitoring extrinsic coronary artery compression related to pulmonary trunk dilatation.

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