Left main coronary artery stenosis secondary to severe pulmonary artery dilation (original) (raw)
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The Anatolian Journal of Cardiology, 2019
Diagnosis and treatment of abnormal left coronary artery originating from the pulmonary artery: A single-center experience Objective: We aimed to review symptoms, findings, surgical treatment options, short-and mid-term outcomes, and reoperation rate of patients diagnosed with of left coronary artery from the pulmonary artery (ALCAPA) of an anomalous origin in our institution. Methods: From May 2000 to March 2018, 33 patients who had left coronary artery originating from the pulmonary artery were retrospectively examined. The clinical features of patients, diagnostic tools and their efficacy, outcomes of surgical repair, and problems during follow-up were evaluated. Results: Thirty-three patients (22 females, 11 males) were included in the study. At the time of surgery, the median age and weight of patients were 6 months (minimum/maximum, 1-166 months) and 6.5 kg (minimum/maximum, 3-38.5 kg), respectively. The mean follow-up was 5±3.5 years (range, 1-16 years). Dyspnea, tachypnea, diaphoresis, prolonged feeding time, and developmental delay were common presenting signs and symptoms. It was determined that all the patients who were diagnosed at another center reached our center for surgical treatment within 1 month. Twenty-three (69.7%) patients had pathologic Q wave with anterior and/or anterolateral myocardial infarction signs on an electrocardiogram (ECG), whereas 22 (66.6%) patients had ST-T segment changes. Twenty-one (63.6%) patients had cardiomegaly on the telecardiogram. A reimplantation surgery was performed to 22 patients and 10 patients underwent the Takeuchi procedure. In addition to ALCAPA repair, 5 patients needed mitral valve plasty. Atrial septal defect (ASD) and ventricular septal defect (VSD) were closed in one patient, and Tetralogy of Fallot was totally corrected in another. At discharge, there was a significant improvement in left ventricular (LV) systolic functions. At the last visit, all patients had normal LV systolic functions except four who had mild dysfunction. The mean follow-up of the four patients was 2.8 years. In the early postoperative period, complications were seen in 10 patients. Five patients died in the early postoperative period, while one patient died 9 months after the ALCAPA surgery because of low cardiac output syndrome that developed after mitral repair. Conclusion: Patients with ALCAPA commonly present with congestive heart failure symptoms. When the diagnosis is confirmed in these patients, surgical treatment should not be delayed. The availability of surgical center and surgery outcomes for ALCAPA diagnosed patients are comparable with other countries, but the delay in the diagnosis of disease is still a problem in our country.
International Journal of Cardiology, 2007
The extrinsic compression of left main coronary artery (LMCA) by dilated pulmonary artery is rarely reported. Various congenital and acquired diseases were shown to cause extrinsic LMCA compression. Here we present a child with aortic root and LMCA compression due to dilated pulmonary trunk and causing angina like chest pain. The patient had also electrocardiographic evidence of myocardial ischemia. This case report will be a guide for the evaluation and surgical treatment of the patients with pulmonary hypertension and LMCA compression.
Left main coronary artery compression from right pulmonary artery stenting
Catheterization and Cardiovascular Interventions, 2009
Complications related to pulmonary artery stenting include stent migration, jailing of vessels, vessel rupture, and compression of surrounding structures. Compression of the left main coronary artery (LMCA) as a result of stent placement in the right pulmonary artery (RPA) is extremely rare. We present two patients post repair of congenital heart disease who suffered LMCA compression following RPA stenting. The first patient experienced acute coronary insufficiency in the cardiac catheterization laboratory, whereas the second patient had a more chronic course. We also present a third patient who had a CT angiogram that demonstrated a close spatial relationship between the RPA and the LMCA. Based on our previous experiences, we felt that this patient was at significant risk for LMCA compression if the RPA were stented. Coronary compression is rare complication of pulmonary artery stenting but should be considered in cases with history of repaired congenital heart disease. '
Journal of Nuclear Cardiology, 2006
Case report. An 8-month-old girl presented with poor ventricular function and mitral insufficiency after reimplantation of an anomalous left coronary artery at another institution. After her mother had a full-term uncomplicated pregnancy, at age 3 months, the patient had been evaluated for shortness of breath with feeding. She was found to have congestive heart failure and a cardiac murmur. Left heart catheterization and coronary angiography revealed an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). The patient underwent open-heart surgery with surgical reimplantation of the left coronary artery to the anterior aspect of the ascending aorta on Nov 30, 2004, at another institution. She had a slow postoperative recovery, requiring mechanical ventilation for 1 week after surgery. Upon discharge, she showed clinical improvement and did well for some time. At age 7 months, the patient was not gaining weight appropriately and was reevaluated for coronary ischemia. Left heart catheterization on March 14, 2005, revealed an enlarged left atrium and left ventricle, as well as a reduced left ventricular (LV) ejection fraction (EF) of 18%. Right heart catheterization was normal. Coronary angiography revealed significant narrowing and near occlusion of the left main coronary artery. The right coronary artery was observed to be enlarged and provided collateral flow to the left coronary system. At that point, the patient came to the Cleveland Clinic (Cleveland, Ohio) for a second opinion. Echocardiography at our institution revealed moderate LV dilatation (2.8 cm in diastole) and mild LV systolic dysfunction (EF, 50%). Given the uncertainty about the significance of the lesion in the left main coronary artery and the discrepancy in LV function, an alternative functional test was considered. The patient proceeded to cardiac positron emission