Hybrid treatment of coronary artery disease and collateral steal effect in a patient with congenital absence of the right pulmonary artery

Research output: Unpublished contribution to conferencePoster

Abstract

OBJECTIVE Unilateral absence of the pulmonary artery is a rare congenital malformation often associated with other cardiac anomalies. In most cases the right pulmonary artery is involved, and the distal part of the affected lung receives its blood supply from systemic collaterals, such as bronchial, intercostal, internal mammary, subclavian arteries. We describe a complex case of a symptomatic adult patient where a major collateral came from a coronary artery.
METHODS A 52-year-old man was referred for angina. The angiography showed a significant stenosis of the left anterior descending artery (LAD) and right coronary artery (RCA), which were stented. A collateral arising from the left circumflex artery (LCx) to the right lung was diagnosed. Absence of the right pulmonary artery was confirmed by CT. Symptoms persisted and a new angiography showed an RCA restenosis, which was again stented. However, the patient continued to have angina and a third angiography demonstrated significant stenosis of the LCx and the LAD.
RESULTS: Off-pump coronary artery bypass surgery was performed with a free left internal mammary artery to the LAD (the left lung was overdeveloped) and a vein to the LCx. The postoperative follow-up was complicated by recurrence of ischemia. A fourth angiography was performed which showed good patency of the grafts, but a steal effect from the collateral of the proximal LCx. The decision was made to stent the LCx and the patient remained asymptomatic.
CONCLUSION: Unilateral absence of the pulmonary artery with a major collateral coming from a coronary artery combined with coronary artery disease can be a complex problem that necessitates a hybrid PCI and off-pump CABG revascularization strategy to avoid infarction of the affected lung.
Original languageEnglish
Publication statusPublished - 2020
EventE-poster session presented at Virtual Belgian Surgical Week -
Duration: 25 Nov 202027 Nov 2020

Conference

ConferenceE-poster session presented at Virtual Belgian Surgical Week
Period25/11/2027/11/20

Fingerprint Dive into the research topics of 'Hybrid treatment of coronary artery disease and collateral steal effect in a patient with congenital absence of the right pulmonary artery'. Together they form a unique fingerprint.

Cite this