Anomalous left coronary artery from the pulmonary artery: a 15 year sample.

Abstract

Eleven patients with anomalous left coronary artery arising from the pulmonary artery were identified from the beginning of 1970 to the end of 1985. The only male patient presented at the age of eight years for assessment of a murmur and was symptom free. The remainder presented in infancy with features of cardiac failure. The electrocardiogram was abnormal in all patients, the majority showing anterolateral ischaemia. Cross sectional echocardiography when available showed a dilated, poorly contracting left ventricle, and in two cases what appeared to be a "normal" origin of the left coronary artery. Aortography was performed in 10 patients and led to the correct diagnosis in eight. The diagnosis was made at necropsy in three infants. One patient has remained well without treatment. The anomalous left coronary artery was ligated in three of the earlier patients, including the asymptomatic boy. Two of these cases had concurrent saphenous vein graft to the anomalous left coronary artery. The four most recent cases were treated by successful direct reimplantation of the anomalous left coronary artery to the aorta when they first presented in infancy. They continue to improve symptomatically and show objective improvement of myocardial function. In this recent experience supports our policy of early surgical re-establishment of a two coronary system from the aorta.

Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery Detected by Echocardiography in an Asymptomatic Adult

“…ALCAPA is a rare congenital malformation accounting for approximately 0.25-0.5% of all congenital heart disease (1). During the fetal period, both systemic and pulmonary arterial pressures and oxygen saturation are equal.…”

“…Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital malformation, also known as Bland-White-Garland syndrome (1). It is unusual for an ALCAPA patient to survive to adulthood; therefore misdiagnosis easily occurs because of atypical clinical presentation or due to the unawareness of such a case.…”

Task Force on Sudden Cardiac Death of the European Society of Cardiology

“…Anomalous origin of the right coronary artery from the left sinus of Valsalva has also been reported to be associated with SCD but may not have the same risk as an anomalous origin of the left coronary artery [419,420,422] . SCD is also the most common cause of death in patients with anomalous left coronary artery arising from the pulmonary artery who survive to adulthood [423,424] .…”

“…In patients with an anomalous left coronary artery arising from the pulmonary artery, direct reimplantation of the left coronary artery into the aorta improves mortality and long-term morbidity [424] . In patients with aberrant origin of the left or right coronary artery who were successfully resuscitated from ventricular fibrillation, surgical intervention (usually bypass grafting) is appropriate.…”

Exercise performance after repair of anomalous origin of the left coronary artery from the pulmonary artery.

“…There seems to be a general consensus that establishing a two coronary artery system is preferable to assure adequate myocardial perfusion. [1][2][3][4][5][6][7] To aid in the evaluation of cardiac function of patients with anomalous origin of the left coronary from the pulmonary artery, this study evaluated the exercise performance of a group of patients who had undergone surgical repair of this defect. We evaluated both myocardial performance and, using thallium 201 scintigraphy, postoperative myocardial perfusion.…”