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Total Occlusion of Left Main Coronary Artery by Dilated Main Pulmonary Artery in a Patient with Severe Pulmonary Hypertension

 Juyong Lee  ;  Hyuck Moon Kwon  ;  Bum Kee Hong  ;  Hae Kyoon Kim  ;  Ki Whan Kwon  ;  Jae Young Kim  ;  Kyo Jun Lee  ;  Tae Soo Kang  ;  Dong Soo Kim  ;  Young Hak Shin  ;  Jin Seon Leem  ;  Hyun Seung Kim 
 KOREAN JOURNAL OF INTERNAL MEDICINE, Vol.16(4) : 265-269, 2001 
Journal Title
Issue Date
Adult ; Constriction, Pathologic/diagnostic imaging ; Constriction, Pathologic/etiology ; Coronary Disease/diagnostic imaging ; Coronary Disease/etiology* ; Dilatation, Pathologic/etiology ; Eisenmenger Complex/diagnosis ; Female ; Heart Septal Defects, Atrial/complications* ; Humans ; Hypertension, Pulmonary/complications* ; Pulmonary Artery*/diagnostic imaging ; Radiography
Heart Septal Defects, Atrial ; Hypertension, Pulmonary ; Coronary disease
A 34-year-old woman was admitted to the hospital because of recently aggravated right heart failure without angina for 5 months. When she was 25 years old, patch repair with Polytetrafluoroethylene (PTFE) was performed for the secondum type of atrial septal defect (ASD) with moderate pulmonary hypertension. The chest PA, echocardiography and cardiac catheterization at current admission revealed Eisenmenger syndrome without intracardiac shunt. Chest CT scan with contrast revealed markedly dilated pulmonary trunk, both pulmonary arteries and concave disfigurement of the left side of the ascending aorta suggesting extrinsic compression, as well as total occlusion of the ostium of the left main coronary artery that was retrogradly filled with collateral circulation from the right coronary artery. The coronary angiography showed normal right coronary artery and the collaterals that come out from the conus branch to the mid-left anterior descending artery (LAD) and that from distal right coronary artery to the left circumflex artery (LCX) and to the distal LAD, respectively. On aortography, the left main coronary artery was not visualized with no stump, suggestive of total occlusion of the ostium of the left main coronary artery. From our experience, it is possible to say that the occlusion of the ostium of the left main coronary can be induced by the dilated pulmonary artery trunk due to ASD with pulmonary hypertension and that, if the ASD closure was too late, the narrowing or obstruction of the left coronary artery could not be resolved even after operation owing to irreversible pulmonary hypertension.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kwon, Hyuck Moon(권혁문) ORCID logo https://orcid.org/0000-0001-9901-5015
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