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Life-threatening left main stenosis induced by compression from a dilated pulmonary artery

Tespili, Maurizio; Saino, Antonio; Personeni, Davide; Silvestro, Antonio; Scopelliti, Pasquale; Banfi, Carlo

Journal of Cardiovascular Medicine: February 2009 - Volume 10 - Issue 2 - p 183–187
doi: 10.2459/JCM.0b013e32831e3f9c
Case reports
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On a rare occasion, pulmonary artery dilatation can be complicated by an extrinsic compression of the left main coronary artery (LMCA) whose effects are immediately evident, whereas a delayed presentation is unusual. We report the uncommon case of a delayed acute coronary syndrome caused by the extrinsic compression of the LMCA due to pulmonary artery enlargement and the potential problems related to its management. An 82-year-old woman with a history of severe chronic obstructive pulmonary disease, a previous episode of deep venous thrombosis and a computed tomography-documented pulmonary artery dilatation was referred to the emergency room for worsening dyspnoea and chest pain. Five days after admission to the coronary care unit, the patient developed a cardiogenic shock with consecutive episodes of ventricular fibrillation. Urgent coronary angiography showed severe LMCA stenosis caused by extrinsic compression from the pulmonary artery with no other lesions in the coronary arteries; coronary angioplasty was successfully performed with a direct drug-eluting stent implantation that led to a significant improvement of the haemodynamic conditions in the following days. Planned control angiography performed 10 days later showed the recurrence of the LMCA stenosis together with a forward displacement of the previously implanted drug-eluting stent, which was managed with a further direct implantation of a bare metal stent. The immediate good results of this second procedure were confirmed by follow-up angiography performed 2 months later and by the 6-month follow-up clinical examination.

aDivision of Cardiology, Ospedale Bolognini, Seriate, Bergamo, Italy

bDivision of Cardiac Surgery, Policlinico San Matteo University Hospital, Pavia, Italy

Received 12 July, 2008

Revised 10 October, 2008

Accepted 17 October, 2008

Correspondence to Maurizio Tespili, MD, Division of Cardiology, A.O. Bolognini, Seriate, Bergamo, Italy Tel: +39 0353063314; fax: +39 0353063635; e-mail: tespili@katamail.com

© 2009 Italian Federation of Cardiology. All rights reserved.