Anomalous origin of the left coronary artery from the right pulmonary artery with intramural aortic trajectory. Clinicosurgical diagnostic implications

Atik, Edmar; Barbero-Marcial, Miguel; Tanamati, Carla; Kajita, Luiz J.; Ebaid, Munir; Jatene, Adib

doi:10.1590/s0066-782x1999000800006

Cited by 8 publications

(6 citation statements)

References 15 publications

(33 reference statements)

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“…Of note, preoperative diagnosis of the intramural aortic course of the anomalous LCA is difficult. Similar to the report by Atik et al, 15 all of our patients were diagnosed during the operation. As such, careful attention should be paid to the potential association of an aortic intramural course before the operation as well as during the operation when dealing with ALCAPA from the RPA.…”

Section: Discussionsupporting

confidence: 90%

“…Importantly, all the 10 cases with such an anomaly were associated with an intramural aortic course but without other congenital heart defects. Reviewing the literature shows that the association has been described in many of the case reports of ALCAPA arising from RPA without other congenital heart defects, [13][14][15] except a few 16,17 that were reported from earlier years, and the aortic intramural course might have been unnoticed. Of note, preoperative diagnosis of the intramural aortic course of the anomalous LCA is difficult.…”

Section: Discussionmentioning

confidence: 93%

“…13 A review of the published data revealed isolated case reports and a small series of 4 cases. [13][14][15] Therefore, we sought to review our diagnostic and surgical experience in a case series of 10 children. The patient characteristics are listed in Table 1.…”

Section: Perspectivementioning

confidence: 99%

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Surgical strategies for anomalous origin of the left coronary artery from the right pulmonary artery with an intramural aortic course: A report of 10 cases

Zhang

Peng

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 93%

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Surgical strategies for anomalous origin of the left coronary artery from the right pulmonary artery with an intramural aortic course: A report of 10 cases

Zhang

Peng

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

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“…Twenty cases of ALCARPA have been documented in the literature. 1 However, there are only 2 reported cases of isolated ALCALPA. 2,3 Our patient is one of the rare cases in which ALCALPA is associated with other congenital anomalies.…”

Section: Discussionmentioning

confidence: 99%

Anomalous left coronary artery arising from the left pulmonary artery, aortic coarctation, and a large ventricular septal defect

Murala

Cooper

Duffy

et al. 2006

The Journal of Thoracic and Cardiovascular Surgery

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“…CT angiography also failed to diagnose the intramural aortic course in two of our cases. However, on reviewing the literature, indicators of latter are as follows: (1) high origin of the LCA at the pulmonary trunk or on the right PA, (2) ascending and parallel course of the ALCAPA to the aortic wall and (3) presence of a left perpendicular angle formed by the junction of the vertical intramural aortic course [30,31]. It is not that ALCARPA always has an intramural course.…”

Section: Mitral Regurgitationmentioning

confidence: 99%

Surgical management of anomalous origin of coronary artery from pulmonary artery

Mishra

2021

Indian J Thorac Cardiovasc Surg

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Background Anomalous origin of coronary artery from pulmonary artery (AOCAPA), as is evident from the name, is defined as abnormal origin of either coronary artery from the pulmonary artery. The consequences vary in most cases and these anomalies lead to severe coronary hypo-perfusion and ventricular dysfunction. The common variants of this cardiac malformation are an anomalous origin of a left coronary artery from a pulmonary artery (ALCAPA) and anomalous origin of the right coronary artery from a pulmonary artery (ARCAPA). Another rare variant is left main coronary artery atresia that resembles ALCAPA in its mode of presentation. This article presents a single surgeon experience of managing this complex subset of the coronary anomaly from April 2006 to July 2019. Material and methods The 105 patients, who underwent surgery for AOCAPA from April 2006 to July 2019, have been included in the study. The patients have been analysed by follow-up echocardiography and electrocardiography (ECG) at our hospital by paediatric cardiologists. Out of 105 patients of AOCAPA, 98 (93.3%) patients underwent ALCAPA repair, of which 59 (60.2%) were males and 39 (39.7%) were females. Four out of five patients, who had an anomalous origin of the left coronary artery from the right pulmonary artery (ALCARPA), had an intramural aortic course. Three patients (3%) had left main coronary artery atresia and four patients (4%) had ARCAPA. It may be mentioned that seven infants (7.14%) and one adult patient (1%) underwent concomitant mitral valve repair. All the patients with ALCAPA, left main coronary artery atresia and ARCAPA, and 1 of the patients with ALCARPA, underwent coronary relocation. In four out of five patients with ALCARPA, unroofing of intraaortic intramural course was performed. Results Out of 105 patients of AOCAPA, 9 (8.5%) patients had in-hospital mortality. Five infants (5.0%) with ALCAPA and one patient (1%) with ALCARPA died in the post-operative period due to severe left ventricular dysfunction, mitral regurgitation (MR) and sepsis. One adult patient (1%) with ALCAPA, who underwent coronary relocation using in situ trap door technique and mitral valve (MV) repair, died due to massive intracranial bleeding. Two patients out of three (66.6%) with left main coronary atresia died in intensive care unit (ICU) after 3rd and 4th postoperative day, due to low cardiac output, severe ventricular dysfunction and severe MR. Patients were followed up for a median 5.9 years. Seven patients were lost to follow-up, including the sole survivor of left main coronary atresia, after a median follow-up of 4 years after surgery. Three patients underwent mitral valve replacement for progressive residual MR. There has been no late mortality. Conclusion AOCAPA is a rare congenital cardiac anomaly, which usually presents in infancy with left ventricular dysfunction and mitral valve regurgitation. Early diagnosis and surgical re-establishment of the dual coronary system has given gratifying results, with improvement in left ventricular function ...

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Anomalous origin of the left coronary artery from the right pulmonary artery with intramural aortic trajectory. Clinicosurgical diagnostic implications

Abstract: Association with other defects usually occurs in the AOLCARPA, and the intramural aortic trajectory is difficult to clinically diagnose but easy to surgically correct.

Cited by 8 publications

References 15 publications

Surgical strategies for anomalous origin of the left coronary artery from the right pulmonary artery with an intramural aortic course: A report of 10 cases

Surgical strategies for anomalous origin of the left coronary artery from the right pulmonary artery with an intramural aortic course: A report of 10 cases

Anomalous left coronary artery arising from the left pulmonary artery, aortic coarctation, and a large ventricular septal defect

Surgical management of anomalous origin of coronary artery from pulmonary artery

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