Angina in Eisenmenger PDA

Angina in Eisenmenger PDA

Angina has been reported in Eisenmenger patent ductus arteriosus, due to compression of left main coronary artery.¹ Compression is usually by the dilated high pressure pulmonary trunk. Left main stenosis can be documented by coronary angiography. Reversal of compression by surgical correction of PDA is seldom feasible at that stage of irreversible obstructive pulmonary vascular disease.

Left main stenting to relieve angina in Eisenmenger PDA

Relief of symptoms by stenting of left main coronary artery in patients with Eisenmenger PDA and angina has been reported.² The patient had presented with rest angina and heart failure due to left ventricular dysfunction. Left main stenting produced immediate relief of angina. They chose a bare metal stent with good radial resistance to prevent extrinsic compression by the systemic pressure in the pulmonary artery which had caused extrinsic uni-directional compression. Six month follow up with multislice computed tomography documented patent left main coronary artery in intimate relation to the dilated pulmonary trunk.

Angina in Eisenmenger PDA is less likely to be due to right ventricular ischemia compared to other forms of Eisenmenger syndrome. This is because right ventricular pressure does not become suprasystemic in Eisenmenger PDA unlike in Eisenmenger atrial septal defect in which suprasystemic right ventricular pressures are common.

References

1. Bijl M, Bronzwaer JG, van Rossum AC, Verheugt FW. Angina pectoris due to left main coronary artery compression in Eisenmenger ductus arteriosus. Am Heart J. 1993;125:1767-71.
2. Sivakumar K, Rajan M, Francis G, Murali K, Bashi V. Extrinsic compression of the left coronary ostium by the pulmonary trunk: management in a case of Eisenmenger syndrome. Tex Heart Inst J. 2010;37:95-8.