Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery: Report of an Adult Case

Abstract

We report the clinical findings, pathophysiology, diagnostic characteristics, and surgical repair of anomalous origin of the left coronary artery from the pulmonary artery in a 26-year-old female patient with a clinical diagnosis of coronary heart disease.Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital defect, and its incidence is estimated in 1:300,000 live births 1 . The clinical evolution varies according to the degree of collateral coronary circulation developed after birth. Anomalous origin of the left coronary artery from the pulmonary artery results in elevated mortality during the first year of life, and only 10% to 15% of the individuals with this defect reach adulthood 2 . The objective of this study was to report the case of an adult with this rare anomaly. Case ReportA 26-year-old black female police officer reported that, 2 months prior to the diagnosis, she had been experiencing intense, sharp, precordial pain not related to physical exertion accompanied by fatigue on strenuous exertion and palpitations. As personal antecedents, she reported several hospitalizations during childhood due to "heart enlargement," and fatigue on great exertion during adolescence. She reported no risk factors for coronary atherosclerotic disease and no familial antecedents of heart disease.On physical examination, the patient was found to be in regular general condition, acyanotic, and had no characteristic facies. She weighed 57kg and was 1.80m tall. Her blood pressure was 112/70mmHg, and her heart rate was 80bpm. Her peripheral pulses were present, symmetric, and of normal amplitude. Her cardiac auscultation revealed rhythmic and normal cardiac sounds of regular intensity and an early-systolic murmur (+/4+) in the mesocardium. The respiratory tract revealed no abnormalities on examination.The chest X-ray revealed a slight enlargement in the cardiac area due to the left ventricle and normal pulmonary vessels.The electrocardiogram showed sinus rhythm, a heart rate of 85 bpm, QRS axis at -60°, Q waves in D1 and aVL with inverted T waves in these leads, indicating an inactive area in the high lateral wall, and a pattern suggestive of left ventricular hypertrophy.The exercise test was effective with no precordialgia, but revealed a 4-mm straightened depression of the ST segment at exertional peak, indicating myocardial ischemia.The two-dimensional echocardiogram showed a slight left ventricular dilation, moderate symmetric myocardial hypertrophy, preserved systolic performance, and prolapse of the mitral valve with slight valvular incompetence. No alterations in the great vessels, coronary arteries, or septal defects were observed.The patient then underwent cardiac catheterization for diagnostic clarification. The procedure was performed via the femoral route according to the technique of Seldinger. The manometry of the right and left chambers was normal. The right coronary artery was of a high caliber, tortuous, and, through collateral vessels, it retrogradely filled the left co...

Anomalous origin of the left coronary artery from the pulmonary artery presenting as dilated cardiomyopathy: a case report

“…ALCAPA occurs approximately in 0.25 to 0.5% of children with congenital heart disease [6]. It is usually an isolated cardiac anomaly but, in 5% of the cases, has been described with coarctation of the Ao, atrial or ventricular septal defects [7]. During the fetal period, both systemic and pulmonary arterial pressures and oxygen saturation are equal.…”

Adult type anomalous origin of the left coronary artery from the pulmonary artery: When should we be aware?

“…On electrocardiography, ALCAPA has characteristic alterations compatible with infarction of the anterolateral wall, frequent deviation of the electric axis to the left, and left ventricular hypertrophy [4]. However a normal baseline ECG can't eliminate the diagnosis of ALCAPA as seen in the present case.…”

Pulmoner arterden kaynaklanan sol koroner arter anomalisi (ALCAPA) olan 11 yaşında yakınmasız olgu

“…Daha ileri yaşlarda büyüme ve gelişme geriliği, sol ventrikül kasılma bozukluğu ve ilerleyici genişleme nedeniyle taşikardi, pulmoner venöz konjesyon nedeniyle dispne, sistemik venöz konjesyon nedeniyle karaciğer büyüklüğü saptanabilir (9). Kollateral arterlerin iyi gelişmesi sayesinde hastaların az bir kısmı ergenlik dönemi ve erişkin yaşa ulaşırken, hastaların %85 kadarı yetersiz kollateraller nedeniyle ilk bir yaşta kaybedilmektedir (10)(11)(12)(13). Olgumuzda bu klinik belirtilerden hiçbiri saptanmamıştır.…”