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Stenting To Reverse Left Ventricular Ischemia Due To Left Main Coronary Artery Compression in Primary Pulmonary Hypertension*

Stuart Rich, MD, FCCP; Vallerie V. McLaughlin, MD; William O’Neill, MD
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*From the Section of Cardiology (Drs. Rich and McLaughlin), Rush Medical College, Chicago, IL; and the Division of Cardiology (Dr. O’Neill), William Beaumont Hospital, Royal Oak, MI.

Correspondence to: Stuart Rich, MD, FCCP, the Rush Heart Institute, Center For Pulmonary Heart Disease, Rush-Presbyterian-St. Luke’s Medical Center, 1725 West Harrison St, Suite 020, Chicago, IL 60612-3824; e-mail: srich@rush.edu



Chest. 2001;120(4):1412-1415. doi:10.1378/chest.120.4.1412
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Angina is a common symptom of severe pulmonary hypertension. Although many theories for the source of this pain have been proposed, right ventricular ischemia is the one most commonly accepted as the cause. We report on two patients with primary pulmonary hypertension who had angina with normal activity or on provocation. One patient had severe left ventricular dysfunction. Both were found to have severe ostial stenosis of the left main coronary artery as a result of compression from a dilated pulmonary artery. Both patients underwent stenting of the left main coronary artery with excellent angiographic results, and complete resolution of the signs and symptoms of angina and left ventricular ischemia. Left ventricular ischemia due to compression of the left main coronary artery may be a much more common mechanism of angina and left ventricular dysfunction in patients with pulmonary hypertension than previously acknowledged. Stenting of the coronary artery can be done safely with the resolution of these symptoms.

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