Pulmonary artery hemodynamic response to proximal balloon dilatation of a large dominant right coronary artery

The human right ventricle has a relatively low tolerance to even short periods of ischemia. During angioplasty of the right coronary artery, pulmonary artery pressure typically rises due to an increase in right ventricular afterload caused by left ventricular dysfunction during ischemia. We have presented two cases of angioplasty in the early proximal portion of a large, highly dominant right coronary artery. Pulmonary artery and systemic pressure fell during balloon inflation probably secondary to acute severe right ventricular failure, though an interaction with left ventricular dysfunction cannot be excluded. These observations do emphasize the hemodynamic and combined ventricular consequences of proximal angioplasty in a large, dominant right coronary artery, particularly in the setting of preexisting left ventricular dysfunction.