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Стеноз ствола левой коронарной артерии при идиопатической легочной гипертензии. Клинический случай
Стеноз ствола левой коронарной артерии при идиопатической легочной гипертензии. Клинический случай
Иванов С.Н., Едемский А.Г., Васильцева О.Я., Чернявский А.М., Калашникова М.В., Селецкая С.В. Стеноз ствола левой коронарной артерии при идиопатической легочной гипертензии. Клинический случай. Consilium Medicum. 2022;24(12):876–881. DOI: 10.26442/20751753.2022.12.201903
© ООО «КОНСИЛИУМ МЕДИКУМ», 2022 г.
© ООО «КОНСИЛИУМ МЕДИКУМ», 2022 г.
________________________________________________
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Аннотация
В статье приведен клинический случай комплексного лечения пациента с идиопатической легочной гипертензией и редким осложнением в виде стеноза ствола левой коронарной артерии, вызванного экстравазальной компрессией расширенной легочной артерией. Данное осложнение клинически проявилось болевым синдромом. Пациенту выполнена чрескожная транслюминальная баллонная ангиопластика со стентированием левой коронарной артерии и последующее назначение комбинированной ЛАГ-специфической терапии. При контрольном обследовании в отдаленном послеоперационном периоде помимо субъективного улучшения самочувствия и отсутствия болевого синдрома у пациента увеличилась дистанция теста 6-минутной ходьбы, отмечена положительная динамика показателей эхокардиографии, катетеризации правых отделов сердца, а также лабораторного маркера сердечной недостаточности NT-proBNP.
Ключевые слова: легочная артериальная гипертензия, идиопатическая легочная гипертензия, стеноз ствола левой коронарной артерии, лечение идиопатической легочной гипертензии, стентирование ствола левой коронарной артерии
Keywords: pulmonary arterial hypertension, idiopathic pulmonary hypertension, stenosis of the left coronary artery, treatment of PAH, stenting of the left coronary artery
Ключевые слова: легочная артериальная гипертензия, идиопатическая легочная гипертензия, стеноз ствола левой коронарной артерии, лечение идиопатической легочной гипертензии, стентирование ствола левой коронарной артерии
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Keywords: pulmonary arterial hypertension, idiopathic pulmonary hypertension, stenosis of the left coronary artery, treatment of PAH, stenting of the left coronary artery
Полный текст
Список литературы
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14. Akbal OY, Kaymaz C, Tanboga IH, et al. Extrinsic compression of left main coronary artery by aneurysmal pulmonary artery in severe pulmonary hypertension: its orrelates, clinical impact, and management strategies. Eur Heart J Cardiovasc Imaging. 2018;19(11):1302-8. DOI:10.1093/ehjci/jex303
15. Симакова М.А., Марукян Н.В., Гуков К.Д., и др. Компрессия ствола левой коронарной артерии аневризмой ствола легочной артерии у пациентов с длительно существующей легочной артериальной гипертензией. Кардиология. 2018;58:22-32 [Simakova MA, Marukian NV, Gukov KD, et al. Kompressiia stvola levoi koronarnoi arterii anevrizmoi stvola legochnoi arterii u patsientov s dlitel'no sushchestvuiushchei legochnoi arterial'noi gipertenziei. Kardiologiia. 2018;58:22-32 (in Russian)].
16. Demerouti EA, Manginas AN, Athanassopoulos GD, Karatasakis GT. Complications Leading to Sudden Cardiac Death in Pulmonary Arterial Hypertension. Respir Care. 2013;58(7):1246-54. DOI:10.4187/respcare.02252
17. Kushner FG, Hand M, Smith SC, et al. 2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2009;120(22):2271-306. DOI:10.1161/CIRCULATIONAHA.109.192663
18. Vaseghi M, Lee JS, Currier JW. Acute myocardial infarction secondary to left main coronary artery compression by pulmonary artery aneurysm in pulmonary arterial hypertension. J Invasive Cardiol. 2007;19(12):E375-7.
19. Demerouti E, Manginas A, Athanassopoulos G, et al. Complications leading to sudden cardiac death in pulmonary arterial hypertension. Respir Care. 2013;58:1246-54.
20. Kajita L, Martinez E, Ambrose J, et al. Extrinsic compression of the left main coronary artery by a dilated pulmonary artery: clinical, angiographic, and hemodynamic determinants. Catheter Cardiovasc Interv. 2001;52(1):49-54.
21. Dodd J, Maree A, Palacios I, et al. Images in cardiovascular medicine. Left main coronary artery compression syndrome: evaluation with 64-slice cardiac multidetector computed tomography. Circulation. 2007;115:e7-8.
22. Galiè N, Saia F, Palazzini M, et al. Left Main Coronary Artery Compression in Patients with Pulmonary Arterial Hypertension and Angina. J Am Coll Cardiol. 2017;69(23):2808-17.
23. Tespili M, Saino A, Personeni D, et al. Life-threatening left main stenosis induced by compression from a dilated pulmonary artery. J Cardiovasc Med (Hagerstown). 2009;10(2):183-7.
24. Corday E, Gold H, Kaplan L, аt al. Coronary artery compression: an explanation for the cause of coronary insufficiency in pulmonary hypertension. Trans Am Coll Cardiol. 1957;7:93-103.
25. Choi Y-J, Kim U, Lee J-S, et al. A Case of Extrinsic Compression of the Left Main Coronary Artery Secondary to Pulmonary Artery Dilatation. J Korean Med Sci. 2013;28(10):1543-8.
26. Kawut SM, Silvestry FE, Ferrari VA, et al. Extrinsic compression of the left main coronary artery by the pulmonary artery in patients with long-standing pulmonary hypertension. Am J Cardiol. 1999;83(6):984-6.
27. Dakkak W, Tonelli AR. Compression of adjacent anatomical structures by pulmonary artery dilation. Postgrad Med. 2016;128(5):451-9. DOI:10.1080/00325481.2016.1157442
28. Gomez A, Bialostozky D, Zajarias A, et al. Right ventricular ischemia in patients with primary pulmonary hypertension. J Am Coll Cardiol. 2001;38:1137-42.
29. Mesquita S, Castro C, Ikari NM, et al. Likelihood of left main coronary artery compression based on pulmonary trunk diameter in patients with pulmonary hypertension. Am J Med. 2004;116:369-74.
30. Demerouti E, Manginas A, Petrou E, et al. Cardiac Dual-source Computed Tomography for the Detection of Left Main Compression Syndrome in Patients with Pulmonary Hypertension. Open Cardiovasc Med J. 2016;10:130-7. DOI:10.2174/1874192401610010130
31. Godfrey A. A 55-year-old woman with pulmonary hypertension, worsening dyspnea, and chest pain. Chest. 2014;145(3):6425.
32. Pina Y, Exaire J, Zarate JS. Left main coronary artery extrinsic compression syndrome: a combined intravascular ultrasound and pressure wire. J Invasive Cardiol. 2006;18(3):102-4.
2. Humbert M, Kovacs G, Hoeper M, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022;43(38):3618-731. DOI:10.1093/eurheartj/ehac237
3. Chazova IE, Martyniuk TV, Valieva ZS, et al. Evraziiskie klinicheskie rekomendatsii po diagnostike i lecheniiu legochnoi gipertenzii. Evraziiskii kardiologicheskii zhurnal. 2020;1:78-122 (in Russian).
4. Belenkov IuN, Chazova IE. Pervichnaia legochnaia gipertenziia. Moscow: Nolidzh, 1999 (in Russian).
5. Chazova IE, Martyniuk TV. Legochnaia gipertenziia. Moscow: Praktika, 2015 (in Russian).
6. Thenappan N, Ormiston ML, Ryan JJ, Archer SL. Pulmonary arterial hypertension: pathogenesis and clinical management. BMJ. 2018;360:j5492. DOI:10.1136/bmj.j5492
7. Chazova IE, Arkhipova OA, Martynyuk TV. Pulmonary arterial hypertension in Russia: six-year observation analysis of the National Registry. Terapevticheskii Arkhiv (Ter. Arkh.). 2019;91(1):10-31 (in Russian). DOI:10.26442/00403660.2019.01.000024
8. Humbert M, Guignabert C, Bonnet S, et al. Pathology and pathobiology of pulmonary hypertension: state of the art and research perspectives. Eur Respir J. 2019;53:1801887. DOI:10.1183/13993003.01887-2018
9. Simonneau G, Montani D, Celermajer DS, et al. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Respir J. 2019;53(57):1801913. DOI:10.1183/13993003.01913-2018
10. Escribano-Subias P, Blanco I, Lopez-Meseguer M, et al. Survival in pulmonary hypertension in Spain: insights from the Spanish registry. Eur Respir J. 2012;40:596-603.
11. Peacock AJ, Murphy NF, McMurray JJ, et al. An epidemiological study of pulmonary arterial hypertension. Eur Respir J. 2007;30:104-9.
12. Bykov AN. Kliniko-anatomicheskie osobennosti koronarnogo krovotoka u patsientov s idiopaticheskoi legochnoi arterial'noi gipertenziei: dis. ... kand. med. nauk. Ekaterinburg, 2019 (in Russian).
13. van Wolferen SA, Marcus JT, Westerhof N, et al. Right coronary artery flow impairment in patients with pulmonary hypertension. Eur Heart J. 2008;29:120-7.
14. Akbal OY, Kaymaz C, Tanboga IH, et al. Extrinsic compression of left main coronary artery by aneurysmal pulmonary artery in severe pulmonary hypertension: its orrelates, clinical impact, and management strategies. Eur Heart J Cardiovasc Imaging. 2018;19(11):1302-8. DOI:10.1093/ehjci/jex303
15. Simakova MA, Marukian NV, Gukov KD, et al. Kompressiia stvola levoi koronarnoi arterii anevrizmoi stvola legochnoi arterii u patsientov s dlitel'no sushchestvuiushchei legochnoi arterial'noi gipertenziei. Kardiologiia. 2018;58:22-32 (in Russian).
16. Demerouti EA, Manginas AN, Athanassopoulos GD, Karatasakis GT. Complications Leading to Sudden Cardiac Death in Pulmonary Arterial Hypertension. Respir Care. 2013;58(7):1246-54. DOI:10.4187/respcare.02252
17. Kushner FG, Hand M, Smith SC, et al. 2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2009;120(22):2271-306. DOI:10.1161/CIRCULATIONAHA.109.192663
18. Vaseghi M, Lee JS, Currier JW. Acute myocardial infarction secondary to left main coronary artery compression by pulmonary artery aneurysm in pulmonary arterial hypertension. J Invasive Cardiol. 2007;19(12):E375-7.
19. Demerouti E, Manginas A, Athanassopoulos G, et al. Complications leading to sudden cardiac death in pulmonary arterial hypertension. Respir Care. 2013;58:1246-54.
20. Kajita L, Martinez E, Ambrose J, et al. Extrinsic compression of the left main coronary artery by a dilated pulmonary artery: clinical, angiographic, and hemodynamic determinants. Catheter Cardiovasc Interv. 2001;52(1):49-54.
21. Dodd J, Maree A, Palacios I, et al. Images in cardiovascular medicine. Left main coronary artery compression syndrome: evaluation with 64-slice cardiac multidetector computed tomography. Circulation. 2007;115:e7-8.
22. Galiè N, Saia F, Palazzini M, et al. Left Main Coronary Artery Compression in Patients with Pulmonary Arterial Hypertension and Angina. J Am Coll Cardiol. 2017;69(23):2808-17.
23. Tespili M, Saino A, Personeni D, et al. Life-threatening left main stenosis induced by compression from a dilated pulmonary artery. J Cardiovasc Med (Hagerstown). 2009;10(2):183-7.
24. Corday E, Gold H, Kaplan L, аt al. Coronary artery compression: an explanation for the cause of coronary insufficiency in pulmonary hypertension. Trans Am Coll Cardiol. 1957;7:93-103.
25. Choi Y-J, Kim U, Lee J-S, et al. A Case of Extrinsic Compression of the Left Main Coronary Artery Secondary to Pulmonary Artery Dilatation. J Korean Med Sci. 2013;28(10):1543-8.
26. Kawut SM, Silvestry FE, Ferrari VA, et al. Extrinsic compression of the left main coronary artery by the pulmonary artery in patients with long-standing pulmonary hypertension. Am J Cardiol. 1999;83(6):984-6.
27. Dakkak W, Tonelli AR. Compression of adjacent anatomical structures by pulmonary artery dilation. Postgrad Med. 2016;128(5):451-9. DOI:10.1080/00325481.2016.1157442
28. Gomez A, Bialostozky D, Zajarias A, et al. Right ventricular ischemia in patients with primary pulmonary hypertension. J Am Coll Cardiol. 2001;38:1137-42.
29. Mesquita S, Castro C, Ikari NM, et al. Likelihood of left main coronary artery compression based on pulmonary trunk diameter in patients with pulmonary hypertension. Am J Med. 2004;116:369-74.
30. Demerouti E, Manginas A, Petrou E, et al. Cardiac Dual-source Computed Tomography for the Detection of Left Main Compression Syndrome in Patients with Pulmonary Hypertension. Open Cardiovasc Med J. 2016;10:130-7. DOI:10.2174/1874192401610010130
31. Godfrey A. A 55-year-old woman with pulmonary hypertension, worsening dyspnea, and chest pain. Chest. 2014;145(3):6425.
32. Pina Y, Exaire J, Zarate JS. Left main coronary artery extrinsic compression syndrome: a combined intravascular ultrasound and pressure wire. J Invasive Cardiol. 2006;18(3):102-4.
2. Humbert M, Kovacs G, Hoeper M, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022;43(38):3618-731. DOI:10.1093/eurheartj/ehac237
3. Чазова И.Е., Мартынюк Т.В., Валиева З.С., и др. Евразийские клинические рекомендации по диагностике и лечению легочной гипертензии. Евразийский кардиологический журнал. 2020;1:78-122 [Chazova IE, Martyniuk TV, Valieva ZS, et al. Evraziiskie klinicheskie rekomendatsii po diagnostike i lecheniiu legochnoi gipertenzii. Evraziiskii kardiologicheskii zhurnal. 2020;1:78-122 (in Russian)].
4. Беленков Ю.Н., Чазова И.Е. Первичная легочная гипертензия. М.: Нолидж, 1999 [Belenkov IuN, Chazova IE. Pervichnaia legochnaia gipertenziia. Moscow: Nolidzh, 1999 (in Russian)].
5. Чазова И.Е., Мартынюк Т.В. Легочная гипертензия. М.: Практика, 2015 [Chazova IE, Martyniuk TV. Legochnaia gipertenziia. Moscow: Praktika, 2015 (in Russian)].
6. Thenappan N, Ormiston ML, Ryan JJ, Archer SL. Pulmonary arterial hypertension: pathogenesis and clinical management. BMJ. 2018;360:j5492. DOI:10.1136/bmj.j5492
7. Чазова И.Е., Архипова О.А., Мартынюк Т.В. Легочная артериальная гипертензия в России: анализ шестилетнего наблюдения по данным Национального регистра. Терапевтический архив. 2019;91(1):10-31 [Chazova IE, Arkhipova OA, Martynyuk TV. Pulmonary arterial hypertension in Russia: six-year observation analysis of the National Registry. Terapevticheskii Arkhiv (Ter. Arkh.). 2019;91(1):10-31 (in Russian)]. DOI:10.26442/00403660.2019.01.000024
8. Humbert M, Guignabert C, Bonnet S, et al. Pathology and pathobiology of pulmonary hypertension: state of the art and research perspectives. Eur Respir J. 2019;53:1801887. DOI:10.1183/13993003.01887-2018
9. Simonneau G, Montani D, Celermajer DS, et al. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Respir J. 2019;53(57):1801913. DOI:10.1183/13993003.01913-2018
10. Escribano-Subias P, Blanco I, Lopez-Meseguer M, et al. Survival in pulmonary hypertension in Spain: insights from the Spanish registry. Eur Respir J. 2012;40:596-603.
11. Peacock AJ, Murphy NF, McMurray JJ, et al. An epidemiological study of pulmonary arterial hypertension. Eur Respir J. 2007;30:104-9.
12. Быков А.Н. Клинико-анатомические особенности коронарного кровотока у пациентов с идиопатической легочной артериальной гипертензией: дис. ... канд. мед. наук. Екатеринбург, 2019 [Bykov AN. Kliniko-anatomicheskie osobennosti koronarnogo krovotoka u patsientov s idiopaticheskoi legochnoi arterial'noi gipertenziei: dis. ... kand. med. nauk. Ekaterinburg, 2019 (in Russian)].
13. van Wolferen SA, Marcus JT, Westerhof N, et al. Right coronary artery flow impairment in patients with pulmonary hypertension. Eur Heart J. 2008;29:120-7.
14. Akbal OY, Kaymaz C, Tanboga IH, et al. Extrinsic compression of left main coronary artery by aneurysmal pulmonary artery in severe pulmonary hypertension: its orrelates, clinical impact, and management strategies. Eur Heart J Cardiovasc Imaging. 2018;19(11):1302-8. DOI:10.1093/ehjci/jex303
15. Симакова М.А., Марукян Н.В., Гуков К.Д., и др. Компрессия ствола левой коронарной артерии аневризмой ствола легочной артерии у пациентов с длительно существующей легочной артериальной гипертензией. Кардиология. 2018;58:22-32 [Simakova MA, Marukian NV, Gukov KD, et al. Kompressiia stvola levoi koronarnoi arterii anevrizmoi stvola legochnoi arterii u patsientov s dlitel'no sushchestvuiushchei legochnoi arterial'noi gipertenziei. Kardiologiia. 2018;58:22-32 (in Russian)].
16. Demerouti EA, Manginas AN, Athanassopoulos GD, Karatasakis GT. Complications Leading to Sudden Cardiac Death in Pulmonary Arterial Hypertension. Respir Care. 2013;58(7):1246-54. DOI:10.4187/respcare.02252
17. Kushner FG, Hand M, Smith SC, et al. 2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2009;120(22):2271-306. DOI:10.1161/CIRCULATIONAHA.109.192663
18. Vaseghi M, Lee JS, Currier JW. Acute myocardial infarction secondary to left main coronary artery compression by pulmonary artery aneurysm in pulmonary arterial hypertension. J Invasive Cardiol. 2007;19(12):E375-7.
19. Demerouti E, Manginas A, Athanassopoulos G, et al. Complications leading to sudden cardiac death in pulmonary arterial hypertension. Respir Care. 2013;58:1246-54.
20. Kajita L, Martinez E, Ambrose J, et al. Extrinsic compression of the left main coronary artery by a dilated pulmonary artery: clinical, angiographic, and hemodynamic determinants. Catheter Cardiovasc Interv. 2001;52(1):49-54.
21. Dodd J, Maree A, Palacios I, et al. Images in cardiovascular medicine. Left main coronary artery compression syndrome: evaluation with 64-slice cardiac multidetector computed tomography. Circulation. 2007;115:e7-8.
22. Galiè N, Saia F, Palazzini M, et al. Left Main Coronary Artery Compression in Patients with Pulmonary Arterial Hypertension and Angina. J Am Coll Cardiol. 2017;69(23):2808-17.
23. Tespili M, Saino A, Personeni D, et al. Life-threatening left main stenosis induced by compression from a dilated pulmonary artery. J Cardiovasc Med (Hagerstown). 2009;10(2):183-7.
24. Corday E, Gold H, Kaplan L, аt al. Coronary artery compression: an explanation for the cause of coronary insufficiency in pulmonary hypertension. Trans Am Coll Cardiol. 1957;7:93-103.
25. Choi Y-J, Kim U, Lee J-S, et al. A Case of Extrinsic Compression of the Left Main Coronary Artery Secondary to Pulmonary Artery Dilatation. J Korean Med Sci. 2013;28(10):1543-8.
26. Kawut SM, Silvestry FE, Ferrari VA, et al. Extrinsic compression of the left main coronary artery by the pulmonary artery in patients with long-standing pulmonary hypertension. Am J Cardiol. 1999;83(6):984-6.
27. Dakkak W, Tonelli AR. Compression of adjacent anatomical structures by pulmonary artery dilation. Postgrad Med. 2016;128(5):451-9. DOI:10.1080/00325481.2016.1157442
28. Gomez A, Bialostozky D, Zajarias A, et al. Right ventricular ischemia in patients with primary pulmonary hypertension. J Am Coll Cardiol. 2001;38:1137-42.
29. Mesquita S, Castro C, Ikari NM, et al. Likelihood of left main coronary artery compression based on pulmonary trunk diameter in patients with pulmonary hypertension. Am J Med. 2004;116:369-74.
30. Demerouti E, Manginas A, Petrou E, et al. Cardiac Dual-source Computed Tomography for the Detection of Left Main Compression Syndrome in Patients with Pulmonary Hypertension. Open Cardiovasc Med J. 2016;10:130-7. DOI:10.2174/1874192401610010130
31. Godfrey A. A 55-year-old woman with pulmonary hypertension, worsening dyspnea, and chest pain. Chest. 2014;145(3):6425.
32. Pina Y, Exaire J, Zarate JS. Left main coronary artery extrinsic compression syndrome: a combined intravascular ultrasound and pressure wire. J Invasive Cardiol. 2006;18(3):102-4.
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2. Humbert M, Kovacs G, Hoeper M, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022;43(38):3618-731. DOI:10.1093/eurheartj/ehac237
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Авторы
С.Н. Иванов*1, А.Г. Едемский1, О.Я. Васильцева1, А.М. Чернявский1, М.В. Калашникова2, С.В. Селецкая2
1 ФГБУ «Национальный медицинский исследовательский центр им. акад. Е.Н. Мешалкина» Минздрава России, Новосибирск, Россия;
2 ГБУЗ «Сахалинская областная клиническая больница», Южно-Сахалинск, Россия
*s_ivanov@meshalkin.ru
1 Meshalkin National Medical Research Center, Novosibirsk, Russia;
2 Sakhalin Regional Clinical Hospital, Yuzhno-Sakhalinsk, Russia
*s_ivanov@meshalkin.ru
1 ФГБУ «Национальный медицинский исследовательский центр им. акад. Е.Н. Мешалкина» Минздрава России, Новосибирск, Россия;
2 ГБУЗ «Сахалинская областная клиническая больница», Южно-Сахалинск, Россия
*s_ivanov@meshalkin.ru
________________________________________________
1 Meshalkin National Medical Research Center, Novosibirsk, Russia;
2 Sakhalin Regional Clinical Hospital, Yuzhno-Sakhalinsk, Russia
*s_ivanov@meshalkin.ru
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