{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:50:02Z","timestamp":1753876202133,"version":"3.41.2"},"reference-count":11,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T00:00:00Z","timestamp":1745452800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"U. N. Mehta Institute of Cardiology and Research Centre"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Extrinsic left main coronary artery (LMCA) compression is well described in patients with severe pulmonary dilatation secondary to atrial septal defect, idiopathic pulmonary artery hypertension, and eisenmengerized patent ductus arteriosus. An inferiorly displaced origin of LMCA closer to the left coronary sinus and a dilated pulmonary artery (PA) trunk twice as much as aortic trunk increases risk of extrinsic compression. Such patients are prone to left ventricular ischaemia, malignant ventricular arrhythmia, and sudden cardiac death.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>A 20-year-old girl presented with gradually worsening exertional dyspnoea for the last 5 years was diagnosed to have tetralogy of Fallot with absent pulmonary valve (TOF-APV). After undergoing intra-cardiac repair with bioprosthetic pulmonary valve implantation, she developed a broad complex right bundle branch block with right precordial Q waves (qRBBB), new-onset left ventricular dysfunction, acute decompensated heart failure, and elevated serum cardiac enzymes. Coronary angiogram and intravascular ultrasound examination showed a critically narrowed slit-like LMCA ostium. Percutaneous stenting of LMCA saw resolution of qRBBB and improvement in left ventricle function, after which patient stabilized and could be weaned off ventilatory support.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Left main coronary artery compression after surgical pulmonary valve replacement in TOF-APV occurring few days after the operation may pose diagnostic and therapeutic challenges. Exact mechanism for post-operative compression is not known. It can be hypothesized that the ionotropic agents used in post-operative period, or change in the geometric relationships of pulmonary artery and LMCA due to pulmonary valve implantation, brought out the compression. A case for prophylactic PA size reduction can be made to avoid the possibility of LMCA compression.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytaf190","type":"journal-article","created":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T11:50:30Z","timestamp":1745495430000},"source":"Crossref","is-referenced-by-count":0,"title":["Late post-operative cardiogenic shock from left main coronary compression in tetralogy of Fallot with absent pulmonary valve: a case report"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4463-5433","authenticated-orcid":false,"given":"Shyam S","family":"Kothari","sequence":"first","affiliation":[{"name":"Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC) , Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 ,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vishal","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC) , Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 ,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kartik","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC) , Civil Hospital Campus, Asarwa, Ahmedabad 380016 ,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gowtham","family":"Thakut","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC) , Civil Hospital Campus, Asarwa, Ahmedabad 380016 ,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0686-9586","authenticated-orcid":false,"given":"Rujuta","family":"Parikh","sequence":"additional","affiliation":[{"name":"Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC) , Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 ,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,4,24]]},"reference":[{"key":"2025050907413704200_ytaf190-B1","doi-asserted-by":"crossref","first-page":"2808","DOI":"10.1016\/j.jacc.2017.03.597","article-title":"Left main coronary artery compression in patients with pulmonary arterial hypertension and angina","volume":"69","author":"Gali\u00e8","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"2025050907413704200_ytaf190-B2","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1007\/s00392-022-01999-z","article-title":"Left main coronary artery compression by dilated pulmonary artery in pulmonary arterial hypertension: a systematic review and meta-analysis","volume":"111","author":"Badea","year":"2022","journal-title":"Clin Res Cardiol"},{"key":"2025050907413704200_ytaf190-B3","doi-asserted-by":"crossref","first-page":"E956","DOI":"10.1002\/ccd.29401","article-title":"Left main coronary artery compression in pulmonary hypertension","volume":"97","author":"Labin","year":"2021","journal-title":"Catheter Cardiovasc Interv"},{"key":"2025050907413704200_ytaf190-B4","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/j.jjcc.2017.11.005","article-title":"Progression of pulmonary artery dilatation in patients with pulmonary hypertension coexisting with a pulmonary artery aneurysm","volume":"71","author":"Akagi","year":"2018","journal-title":"J Cardiol"},{"key":"2025050907413704200_ytaf190-B5","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1016\/S0022-5223(19)37539-7","article-title":"Coronary artery compression with fatal myocardial ischemia: a rare complication of valved extracardiac conduits in children with congenital heart disease","volume":"85","author":"Daskalopoulos","year":"1983","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025050907413704200_ytaf190-B6","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/S0003-4975(10)60941-1","article-title":"Coronary artery injury by a valved external conduit","volume":"31","author":"Harris","year":"1981","journal-title":"Ann Thorac Surg"},{"key":"2025050907413704200_ytaf190-B7","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1161\/CIRCINTERVENTIONS.113.000202","article-title":"Risk of coronary artery compression among patients referred for transcatheter pulmonary valve implantation: a multicenter experience","volume":"6","author":"Morray","year":"2013","journal-title":"Circ Cardiovasc Interv"},{"key":"2025050907413704200_ytaf190-B8","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.jcin.2018.08.002","article-title":"Left main coronary artery extrinsic compression in patients with pulmonary arterial hypertension: technical insights and long-term clinical outcomes after stenting","volume":"12","author":"Saia","year":"2019","journal-title":"J Am Coll Cardiol Intv"},{"key":"2025050907413704200_ytaf190-B9","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1016\/j.cjco.2020.12.022","article-title":"Left main coronary artery compression in pulmonary arterial hypertension: percutaneous treatment to improve symptoms","volume":"3","author":"Edginton","year":"2020","journal-title":"CJC Open"},{"key":"2025050907413704200_ytaf190-B10","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1016\/j.jcin.2015.10.044","article-title":"Left main stenting in comparison with surgical revascularization: 10-year outcomes of the (left main coronary artery stenting) LE MANS trial","volume":"9","author":"Buszman","year":"2016","journal-title":"JACC Cardiovasc Interv"},{"key":"2025050907413704200_ytaf190-B11","first-page":"691","article-title":"Clinical relevance of adding intravascular ultrasound to coronary angiography for the diagnosis of extrinsic left main coronary artery compression by a pulmonary artery aneurysm in pulmonary hypertension","volume":"98","author":"Velazquez Martin","year":"2021","journal-title":"Catheter Cardiovasc Interv"}],"container-title":["European Heart Journal - 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