LEFT MAIN CORONARY ARTERY DISEASE IN PATIENTS WITH ATRIAL SEPTAL DEFECTS (ASD)

Abstract

38 year old woman was admitted in National Institute
of Cardiovascular Diseases (NICVD), with
complaints of typical chest pain and progressive
exertion dyspnoe,for last 5 years, currently she was in
NYHA 3 shortness of breath. Physical examination
revealed RV heave, right ventricular s3 and fixed
splitting of second heart sound in all phases of
respiration and grade 111/V1 systolic murmur at right
second intercostals space.ECG showed sinus rhythm
with right axis deviation and signs of right ventricular
hypertrophy and negative T waves in anterior and
inferior leads. Chest x-ray showed cardiomagely with
dilated pulmonary arteries.

Coronary artery stenosis is usually caused by
atherosclerotic disease. However, on rare occasions,
extrinsic compression of the left main coronary artery
(LMCA) is caused by pulmonary artery dilatation.1
The extrinsic compression of left main coronary
artery(LMCA) secondary to pulmonary artery trunk
dilatation is a relatively newly described syndrome
that has been associated with severe pulmonary
hypertension.Cardiac 64-slice, multi-detector CT
scanning provides a comprehensive method for
evaluating the degree of LMCA compression, the
angulations of the LMCA relative to the left sinus of
Valsalva, the evaluation of left and right ventricular
function, and pulmonary pathology both before
surgery and monitoring post surgical follow up.