Abstract
A patient with severe pulmonary (arterial) hypertension (PH) presented with a non-ST segment elevation myocardial infarction and recurrent angina at rest. Coronary angiography showed severe ostial left main coronary artery (LMCA) stenosis; coronary arteries were otherwise normal. Intravascular ultrasonography (IVUS) showed deformation of the LMCA due to extrinsic compression from a markedly dilated main pulmonary artery, which was confirmed by cardiac computed tomography. The LMCA was successfully stented using a paclitaxel-eluting stent resulting in complete resolution of angina. Extrinsic compression of the LMCA should be considered in patients with severe PH and angina; IVUS may aid in the diagnosis. Percutaneous stent implantation may be the preferred treatment in this high-risk group of patients.
MeSH terms
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Acute Coronary Syndrome / etiology
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Acute Coronary Syndrome / pathology
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Acute Coronary Syndrome / therapy*
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Angina Pectoris / etiology
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Angina Pectoris / therapy
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Angioplasty, Balloon, Coronary* / instrumentation
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Cardiovascular Agents / administration & dosage
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Coronary Angiography
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Coronary Stenosis / etiology
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Coronary Stenosis / pathology
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Coronary Stenosis / therapy*
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Dilatation, Pathologic
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Drug-Eluting Stents
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Female
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Humans
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Hypertension, Pulmonary / complications*
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Hypertension, Pulmonary / pathology
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Hypertension, Pulmonary / therapy
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Middle Aged
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Paclitaxel / administration & dosage
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Platelet Aggregation Inhibitors / therapeutic use
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Pulmonary Artery / pathology*
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Severity of Illness Index
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Tomography, X-Ray Computed
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Treatment Outcome
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Ultrasonography, Interventional
Substances
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Cardiovascular Agents
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Platelet Aggregation Inhibitors
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Paclitaxel