Acute myocardial infarction in the elderly with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA): A case report and literature review

Abstract

Introduction: Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital coronary artery malformation, with a fatality rate of 90% at 1 year of age; only 10% to 15% of patients are diagnosed in adulthood. However, elderly survivors are particularly rare. Here, we report a case of elderly ALCAPA presented with acute myocardial infarction. Case presentation: A 64-years-old female, complained of acute precordial pain in our hospital for 2 days. She was diagnosed with an acute non-ST-segment elevation myocardial infarction. Aortic angiography revealed emptiness of the left coronary sinus, and coronary angiography showed that the tortuous right coronary artery supplied blood to the left coronary artery through collateral circulation, and the contrast medium spilled from the opening of the left coronary artery. It was suspected that the left coronary artery was opened in the pulmonary artery. This finding was subsequently confirmed by coronary artery CT. The patient refused surgery to restore double coronary circulation and was administered standardized drug treatment. There was no chest pain during the 6-month follow-up. Conclusion: ALCAPA should be considered in patients with Myocardial Infarction with Non-obstructive Coronary Arteries, and surgical intervention is the first choice for such patients; However, chronic myocardial damage persists regardless of surgical treatment, prophylactic implantation of an ICD may be an important means of preventing sudden cardiac death and such patients should be followed up for a lifetime.

Anomalous origin of the left coronary artery from the right pulmonary artery

“…Anomalous origin of the left coronary artery from the pulmonary artery mostly originates from the left posterior sinus at the root of the PA, which can lead to coronary steal syndrome and myocardial ischemia, and the incidence of the disease is approximately 1/3,00,000, accounting for 0.25%–0.5% of congenital heart diseases 1,2 . In this case, the LCA diverged from the right PA instead of the main PA, which is extremely rare and has never been reported before.…”

Inferior ST-Elevation Myocardial Infarction Secondary to Aortic Mass: A Rare Case Report

“…Post-intervention, close monitoring for potential embolic complications, arrhythmias, or recurrent infarctions is essential. Anticoagulation may be indicated to mitigate the risk of further embolism from the aortic mass (12).…”

Myocardial Infarction and Complete Heart Block in a Patient With Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery (ALCAPA)

“…Adult patients can remain asymptomatic or present with heart failure, angina on exertion, and mitral regurgitation. Only 10-15% of patients survive to adulthood [ 6 ]. Over the age of 50 years, survival is rare [ 7 ].…”