LEFT MAIN CORONARY ARTERY DISEASE IN PATIENTS WITH ATRIAL SEPTAL DEFECTS (ASD)

Abstract

38 year old woman was admitted in National Institute of Cardiovascular Diseases (NICVD), with complaints of typical chest pain and progressive exertion dyspnoe,for last 5 years, currently she was in NYHA 3 shortness of breath. Physical examination revealed RV heave, right ventricular s3 and fixed splitting of second heart sound in all phases of respiration and grade 111/V1 systolic murmur at right second intercostals space.ECG showed sinus rhythm with right axis deviation and signs of right ventricular hypertrophy and negative T waves in anterior and inferior leads. Chest x-ray showed cardiomagely with dilated pulmonary arteries. Coronary artery stenosis is usually caused by atherosclerotic disease. However, on rare occasions, extrinsic compression of the left main coronary artery (LMCA) is caused by pulmonary artery dilatation.1 The extrinsic compression of left main coronary artery(LMCA) secondary to pulmonary artery trunk dilatation is a relatively newly described syndrome that has been associated with severe pulmonary hypertension.Cardiac 64-slice, multi-detector CT scanning provides a comprehensive method for evaluating the degree of LMCA compression, the angulations of the LMCA relative to the left sinus of Valsalva, the evaluation of left and right ventricular function, and pulmonary pathology both before surgery and monitoring post surgical follow up.