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Dynamic compression of the left main coronary artery by the left atrium

Robin A Ducas1, Davinder S Jassal, Iain D C Kirkpatrick

  • 1Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. jducas@sbgh.mb.ca

Journal of Thoracic Imaging
|August 26, 2009
PubMed

Insights

Severe mitral regurgitation caused dynamic compression of the left main coronary artery due to enlarged left atrium. This led to heart failure symptoms and angina in a 67-year-old woman.

Area of Science:

  • Cardiology
  • Cardiac Imaging
  • Vascular Physiology

Background:

  • A 67-year-old woman presented with worsening heart failure and angina.
  • Her medical history included severe mitral valve regurgitation.

Observation:

  • Coronary angiography showed dynamic systolic flow limitation in the left main (LM) coronary artery without atherosclerotic disease.
  • Intravascular ultrasound revealed systolic LM coronary artery distortion and cross-sectional area reduction.
  • Cardiac CT demonstrated left atrial enlargement compressing the LM coronary artery.

Findings:

  • The patient was diagnosed with dynamic compression of the LM coronary artery.
  • This compression was secondary to systolic left atrial enlargement caused by mitral regurgitation.

Implications:

  • This case highlights a rare cause of coronary artery compression.
  • It underscores the importance of considering dynamic mechanical factors in coronary artery disease diagnosis.
  • Accurate diagnosis requires integrated interpretation of angiography, intravascular ultrasound, and cardiac CT.

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