Extrinsic compression of the left main coronary artery (LMCA) by pulmonary artery trunk is rare but has been described as an important etiology of LMCA disease, especially in congenital heart disease patients. It can often be missed if coronaries are not evaluated before surgical closure and should always be kept as a cause when ASD patients present with anginal chest pain [Figures 1–4].
Figure 1.
Echocardiogram showing ostium secundum type of atrial septal defect
Figure 4.
Computed tomography coronary angiogram demonstrating compression of left main by dilated pulmonary artery
Figure 2.
Echocardiogram demonstrating hugely dilated main pulmonary artery
Figure 3.
Coronary angiogram revealing ostial stenosis of left main coronary artery
