A case of coronary artery compression syndrome resulting from peri-valvular regurgitation and long-standing atrial fibrillation

Q4 Medicine

Journal of Cardiology Cases Pub Date : 2024-04-01 DOI:10.1016/j.jccase.2023.12.003

Keisuke Suzuki MD, PhD, Yoshiaki Mibiki MD, PhD, Mai Suzuki MD, Hiroshi Nakagata MD, PhD, Kosuke Aoki MD, Eiji Sato MD, PhD, Yoshihiro Yamashina MD, PhD, Takehiko Miyashita MD, PhD, Akihiko Ishida MD, Tetsuo Yagi MD, PhD

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Abstract

A man in his 70s with a history of mitral valve replacement (MVR) and long-standing persistent atrial fibrillation (AF) presented with effort angina. Coronary angiography revealed severe stenosis of the left main coronary artery (LMCA). As it was an emergent case, PCI (percutaneous coronary intervention) was selected for treatment. Intravascular ultrasonography revealed no atherosclerotic lesions in the LMCA. The LMCA was effectively dilated by the drug-eluting stent. No elevation in intracardiac pressure was observed in cardiac catheterization after PCI. Computed tomography scan indicated potential compression of the LMCA by the surrounding structures. In cases of long-standing persistent AF and an enlarged atrium after MVR, the possibility of LMCA stenosis due to anatomical changes should be considered.

Learning Objectives

◾
Peri-valvular regurgitation and long-standing persistent atrial fibrillation can potentially cause atrial enlargement.
◾
Coronary artery stenosis without atherosclerosis can occur due to compression from surrounding structures or shifting of the coronary artery.
◾
Stent therapy provides a temporary solution and coronary artery bypass grafting or switching should be considered if re-stenosis occurs.

查看原文本刊更多论文

一例因瓣周返流和长期心房颤动导致的冠状动脉压迫综合征病例

一名 70 多岁的男子曾做过二尖瓣置换术 (MVR)，并长期存在持续性心房颤动 (AF)，后来出现费力性心绞痛。冠状动脉造影显示左冠状动脉主干（LMCA）严重狭窄。由于是急诊病例，患者选择了 PCI（经皮冠状动脉介入治疗）治疗。血管内超声检查显示 LMCA 没有动脉粥样硬化病变。药物洗脱支架有效地扩张了 LMCA。PCI 术后的心导管检查未发现心内压升高。计算机断层扫描显示 LMCA 可能受到周围结构的挤压。学习目标◾瓣膜前反流和长期持续性房颤可能导致心房扩大。◾ 没有动脉粥样硬化的冠状动脉狭窄可因周围结构压迫或冠状动脉移位而发生。 ◾ 支架治疗可提供临时解决方案，如果发生再次狭窄，应考虑冠状动脉旁路移植或转换。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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