The Mechanical Cause of Myocardial Infarction in Eisenmenger Syndrome: Unidimensional Left Main Compression

Eisenmenger syndrome may rarely present as acute coronary syndrome due to extrinsic left main compression by the dilated and hypertensive pulmonary artery. Though computed tomography (CT scan) has been the investigation of choice for diagnosis of this entity, high-definition intravascular ultrasound (HD-IVUS) may play a crucial role in diagnosis especially in sick patients with a characteristic finding of a “slit-like” ostia. Treatment of this “left main compression syndrome” with a drug eluting stent of high radial strength, evidenced angiographically as well as by HD-IVUS makes percutaneous coronary intervention (PCI) a preferred strategy to coronary artery bypass graft (CABG) in such high-risk patients.