Adult isolated hypoplasia of left pulmonary artery with exertional angina and abnormal exercise stress test: A case report and treatment implication

Pulmonary artery hypoplasia, either congenital or acquired, is a rare abnor mality seen in adults. We reported the first case of adult, isolated, left pulmonary artery hypoplasia, with exertional angina and prominent ST depres sion in exercise stress test, that seemed to be caused by exertional hypoxe mia. Several vasodilators, including nitroglycerin, prostaglandin El, and n ifedipine, were administered individually, each with subsequent hemodynamic monitoring, pulse oximetric monitoring, and exercise test. Vasodilator adm inistrations reduced pulmonary vascular resistance (baseline, 599; vasodila tors, 306, 211, and 284 dyne (.) sec (.) m(2)/cm(-5), respectively) and att enuated ST depression (by 52, 72, and 27%, respectively) but without an imm ediate benefit on exercise tolerance. All vasodilators except nifedipine am eliorated exertional hypoxemia (expressed by arterial oxygen saturation dur ing peak exercise, baseline, 69%; vasodilators, 85, 78, and 65%, respective ly). Additional oxygen supply after nitroglycerin administration further be nefited exertional hypoxemia (arterial oxygen saturation, 96%) and exercise ST depression (attenuated by 82%).