Percutaneous intervention of left main coronary artery compression by pulmonary artery aneurysm
Marmar Vaseghi1, Michael S Lee, Jesse Currier
1Division of Cardiology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA. mvaseghi@mednet.ucla.edu
Insights
Left main coronary artery (LMCA) stenting effectively treats angina caused by pulmonary artery aneurysm (PAA) compression in pulmonary arterial hypertension (PAH) patients. This feasible and durable procedure offers a valuable alternative for high-risk surgical candidates.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pulmonary Hypertension
Background:
- Pulmonary artery aneurysm (PAA) compression of the left main coronary artery (LMCA) is a recognized cause of angina in pulmonary arterial hypertension (PAH).
- PAH patients face increased surgical risks, necessitating alternative treatment strategies.
Purpose of the Study:
- To evaluate the feasibility and efficacy of LMCA stenting for treating LMCA stenosis caused by PAA.
Main Methods:
- Retrospective analysis of patients with PAH, angina, and LMCA compression due to PAA who underwent percutaneous coronary intervention.
- Diagnosis confirmed by cardiac CT angiography and echocardiography.
Main Results:
- Five female patients (mean age 51) with PAH and angina underwent successful LMCA stenting.
- All patients experienced angina resolution and normalization of ECG abnormalities post-procedure.
- Mean follow-up of 16.6 months showed sustained angina relief, no complications, and confirmed stent patency in 60% of patients.
Conclusions:
- LMCA stenting is a feasible and durable treatment for angina resulting from PAA compression.
- The procedure is well-tolerated and particularly beneficial for PAH patients with elevated surgical risk.
Background:
Extrinsic compression of the left main coronary artery (LMCA) by a pulmonary artery aneurysm (PAA) has become increasingly recognized as an etiology of angina in patients with pulmonary arterial hypertension (PAH). The purpose of this study was to assess the feasibility and efficacy of LMCA stenting in the treatment LMCA stenosis because of PAA.
Methods:
Retrospective analysis of data on patients with PAH who presented with angina and underwent percutaneous intervention of their LMCA compression because of PAA was performed.
Results:
Five patients (age 51 ± 16 years, all female) with PAH presented with angina and underwent LMCA stenting between 2007 and 2009. Four had positive cardiac enzymes. LMCA compression because of a PAA was diagnosed in all patients with cardiac CT angiography after echocardiography demonstrated an enlarged pulmonary artery. LMCA stenting was successfully performed in all patients with resolution of angina and electrocardiographic abnormalities. After a mean follow-up of 16.6 ± 15.7 months (range of 5-39 months), patients remained angina free, no complications of the procedure were noted, and long term stent patency was confirmed in three of the five patients who underwent repeat cardiac CT angiography.
Conclusions:
LMCA stenting appears to be a feasible and durable option in patients who present with angina because of compression by PAA. This procedure was well tolerated and is of particular value given the increased surgical risk in patients with PAH.
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