TY  - EJOU
AU  - Iosifescu, Andrei George 
AU  - Enache, Roxana 
AU  - Marinică, Ioana 
AU  - Radu, Corina 
AU  - Iliescu, Vlad Anton 

TI  - “Treat-Repair-Treat”: Management of Left Main Coronary Compression by a Pulmonary Artery Aneurysm in a Patient with Atrial Septal Defect and Significant Pulmonary Hypertension
T2  - Structural and Congenital Heart Disease

PY  - 2023
VL  - 18
IS  - 1
SN  - 3071-1738

AB  - Left main coronary compression syndrome (LMCS) may complicate pulmonary artery aneurysms (PAA), usually developed in the context of pulmonary arterial hypertension (PAH). We report the case of a 51-year-old female patient with an atrial septal defect (unsuitable for device closure) complicated by a PAA generating a 90% left main stenosis. The significant PAH held us back from immediate surgery. After specific dual PAH-targeted therapy (sildenafil and bosentan), the atrial septal defect could be closed with a unidirectional valved patch; the PAA-induced LMCS was treated by reductive arterioplasty. The postoperative course was uneventful. Follow-up showed clinical improvement, but PAH treatment was still needed. After three months, coronary angiography showed only an insignificant residual left main stenosis, proving that reductive pulmonary arterioplasty was effective in treating LMCS. Any PAA requires further evaluation for LMCS, a dangerous but treatable complication. The “treat-repair-treat” strategy and shunt-closure with a unidirectional valved patch can both improve surgical prospects of LMCS with shunt-related PAH.
KW  - Atrial septal defect; pulmonary arterial hypertension; pulmonary artery aneurysm; left main coronary compression syndrome; surgery; unidirectional valved patch

DO  - 10.32604/chd.2023.026598