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Japanese

Coronary arteriographic findings in the patients with atrial septal defect and pulmonary hypertension (ASD+PH):compression of left main coronary artery by pulmonary trunk Kazuaki Mitsudo 1 , Toshio Fujino 1 , Kazuo Matsunaga 1 , Osamu Doi 1 , Yoshihiro Nishihara 1 , Junji Awa 1 , Tsuyoshi Goto 1 , Toshiaki Hase 1 , Takaaki Sakamoto 1 , Masako Toda 1 , Eitetsu Kou 1 , Masaaki Zenke 1 , Satoki Fujii 1 1Department of Cardiology, Heart Institute, Kurashiki Central Hospital pp.649-655
Published Date 1989/6/15
DOI https://doi.org/10.11477/mf.1404205493
  • Abstract
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The characteristic narrowing of left main coronary artery (LMCA) was found in 44% of patients (pts) with atrial septal defect and pulmonary hypertension (ASD PH). The cause of the narrowing is thought to be the compression by pulmonary trunk (PT).

Cardiac catheterization and coronary arteriography (CAG) were performed in 38 pts with ASD ranging in age from 15 to 62 years. We defined abnormal narrowing as 50% or more stenosis of AHA classi-fication. Sixteen pts (42%) had PH, and of these pts 7 show the abnormal narrowing of LMCA. (18% of all pts with ASD, 44% of pts with ASD+PH). They had no signs of syphilis or aortitis. Of the pts with PH, those with abnormal LMCA revealed higher pulmonary artery mean pressure than those with nor-mal LMCA (43.6±17.3 and 27.1±5.5 mmHg respe-ctively. p<0.01). Other parts of coronary arteries are intact in all pts. These findings suggest that the LMCA abnormality relates to PH.

In all cases with LMCA abnormality the narrow-ing revealed some special features indicate the cause of norrowing is compression. First, the most severe part of narrowing was the coronary ostium, and seve-rity reduced gradually as distal LMCA. Second, the narrowing was estimated most severely in the view of LAO 20, but almost normal in the view of RAO 30. This finding suggests the narrowing is ellipsoid. Third, the shape of LMCA changed in the different phase of cardiac cycle. In the systole, the cranial border of LMCA was convex, but in the diastole it was concave. This indicates LMCA was soft and compressed.

The autopsy of a patient with arteriographically subtotal occlusion of LMCA revealed completely patient LMCA and no findings of inflammation, scle-rosis or anomalous origin of LMCA.

We conclude the narrowing of LMCA in the pts with ASIDi PI-I is caused by compression by enlarged and high-pressured PT. Coronary arteriography is essential for the pts, with ASD+PH and, pts with severe narrowing may have to receive CABG.


Copyright © 1989, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1200 印刷版ISSN 0452-3458 医学書院

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