Arq. Bras. Cardiol. 2025; 122(7): e20250352
Coronary Compression in Pulmonary Hypertension: A Treatable Threat Hidden in Plain Sight
This Short Editorial is referred by the Research article "Left Main Coronary Artery Angioplasty for the Treatment of Extrinsic Compression in Patients with Pulmonary Hypertension".
Pulmonary hypertension (PH) represents a severe, progressive condition associated with right ventricular failure, impaired functional capacity, and increased mortality., Although angina is not a hallmark symptom of PH, it can affect up to 30% of patients and is frequently overlooked in clinical practice. The study published in this issue of Arquivos Brasileiros de Cardiologia addresses a rare yet critical cause of chest pain in PH: extrinsic compression of the left main coronary artery (LMCA) by a dilated pulmonary artery. The authors present an observational case series of 12 patients undergoing percutaneous coronary intervention (PCI) with stenting for LMCA compression, reporting both feasibility and sustained symptom relief.
While LMCA atherosclerosis is well recognized for its prognostic impact, compression of this vessel due to pulmonary artery dilation in PH remains underdiagnosed. The authors highlight that up to 76% of patients with advanced PH exhibit pulmonary artery enlargement, which may result in significant extrinsic compression of the LMCA, even in the absence of coronary atherosclerosis., Importantly, LMCA compression has been associated with sudden cardiac death in PH cohorts, emphasizing the need for high clinical suspicion.–
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