"Treat and repair" strategy for a giant pulmonary artery aneurysm caused by idiopathic pulmonary hypertension and compression of the left main coronary artery.

Abstract

Compression of the left main coronary artery by a giant pulmonary artery aneurysm is a rare but potentially fatal condition, particularly in patients with pulmonary hypertension. Although percutaneous coronary intervention has been attempted, concerns remain regarding stent durability. Surgical intervention provides a definitive solution but carries high perioperative risks. A 67-year-old woman with idiopathic pulmonary arterial hypertension developed exertional chest tightness and left vocal cord paralysis. Imaging revealed a giant pulmonary artery aneurysm compressing the left main coronary artery, causing severe stenosis. Given the high surgical risk, preoperative medical therapy was initiated, successfully lowering pulmonary artery pressure. The patient then underwent pulmonary artery plication, main pulmonary artery conduit replacement, and left main coronary artery patch angioplasty-a unique combination rarely reported in this setting. Postoperative imaging confirmed an adequately expanded left main coronary artery without external compression. This case highlights a "treat and repair" strategy, in which pulmonary hypertension management optimized surgical safety. A multidisciplinary approach is essential, and long-term follow-up is needed to assess the durability of the reconstructed left main coronary artery.