Simultaneous Coronary and Pulmonary Angiography to Diagnose Critical Left Main Coronary Artery Stenosis Secondary to Dilated Pulmonary Artery.

A 68-year-old woman with long-standing severe pulmonary arterial hypertension was referred for coronary catheterization for investigation of worsening exertional dyspnea associated with angina. Coronary angiography revealed critical ostial left main coronary artery (LMCA) stenosis. Given the history of severe pulmonary arterial hypertension, simultaneous angiography of the LMCA and main pulmonary artery (MPA) was performed, which suggested a severely dilated MPA compressing the ostial to mid-LMCA, causing a critical stenosis (Figure 1A). This correlated well with coronary