Angina in left main coronary artery occlusion by pulmonary artery aneurysm

A 51-year-old woman with exercise angina and a history of pulmonary artery hypertension related to a previous pulmonary thromboembolism, was referred to our hospital. Computed tomography and coronary angiography showed a 95-mm aneurysm of the main pulmonary artery, which totally occluded the left main coronary artery. After a multidisciplinary evaluation, we recommended heart-lung transplantation, but the patient refused any kind of surgical procedure. Due to the chronic occlusion, stenting of the left main coronary artery was unfeasible. With no other options available, we could only start pulmonary antihypertensive therapy. At the 1-year follow-up, the patient reported relief of her angina.