A rare case of LMCA stenosis treated by percutaneous coronary intervention (PCI) in setting of patent ductus arteriosus with dilated pulmonary trunk

Extrinsic compression of the Left Main Coronary Artery (LMCA) by a dilated pulmonary artery is a rare but a treatable cause of angina in patients with Pulmonary Artery Hypertension (PAH). In majority of these patients, angina is attributed to right ventricular or left ventricular demand ischemia and in the absence of cardiovascular risk factors for atherosclerosis, they rarely undergo a coronary angiogram. So this rare diagnosis may be missed in such patients and optimal management delayed. In this case report we describe a patient of PAH secondary to Patent Ductus Arteriosus (PDA), presenting with heart failure and complaining of persistent angina, due to extrinsic compression of the ostial LMCA by the dilated pulmonary artery, treated successfully by Percutaneous Coronary Intervention (PCI). This case reminds us that in all patients of pulmonary hypertension presenting with angina and left ventricular dysfunction, this rare but treatable cause should be identified by coronary angiography and treated with PCI.