Percutaneous Coronary Intervention in Patients with Pulmonary Artery Hypertension and Left Main Coronary Artery External Compression

Materials and methods:

External compression of LMCA by dilated PA was suspected in two patients with PAH by computed tomography (CT) scan and confirmed during conventional angiography in the only one projection (LAO 45̊ CRAN 30̊). First patient is 39 years old woman with  Eisenmenger syndrome and reduced left ventricular ejection fraction (LVEF) 40%. Second patient is 55 years old woman with idiopathic PAH. CT scan has shown dilated up to 45 mm PA trunk in diameter in both cases. Clinical status was presented with heart failure NYHA 3 functional class and stable angina CCS 3 functional class. PCI was the choice due to high risk of sudden cardiac death. LMCA with drug eluting stent implantation under optical coherence tomography and intravascular ultrasound guidance was performed in both cases. Minimal vessel area increased from 5,3 mm to 14,7 mm and 5,7 to 17,5 mm after stent implantation, respectively. Clinical status was improved with LVEF increase from 40% to 56% in first case. Six minute walk test increased from 231 m up to 315 m and from 224 m up to 307 m.

Conclusions:

Patients with PAHare at high risk ofsudden death due to pulmonary hypertensive crisis and, as our experience demonstrates, also at probable risk of myocardial infarction. CT Scan and conventional angiography with use of LAO 45̊ CRAN 30̊ projection could be indicated in patients with symptomatic pulmonary artery hypertension and angina pectoris manifestation.