Anomalous Origin of Left Coronary Artery from Pulmonary Artery

Agustsson, Magnus H.

doi:10.1001/jama.1962.03050140017004

Cited by 71 publications

(25 citation statements)

References 16 publications

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“…Since adequate left coronary artery perfusion pressure exceeds that normally present in the pulmonary artery, the anastomotic circulation must be sufficient to supply a large enough flow of blood from the left coronary artery into the pulmonary artery to maintain a significant pressure gradient between the peripheral components of the left coronary artery vascular bed and the pulmonary artery. That blood flow is from the anomalous left coronary artery into the pulmonary artery in long-term survivors is supported by evidence cited by Edwards (1958), Jurishica (1957), George and Knowlan (1959), and Lampe and Verheugt (1960), and most recently in 2 of the 3 cases reported by Agustsson et al (1962). The surviving adults have usually not had a known history of illness in infancy, although the reliability of the evidence may be questioned.…”

Section: Discussionmentioning

confidence: 91%

“…ligation of the anomalous coronary artery (Agustsson et al, 1962;Case et al, 1958;Sabiston et al, 1960). To be successful, the procedure must improve coronary perfusion, and logically this could only result if predominant blood flow was from the anomalous left coronary artery into the pulmonary artery as observed in Sabiston et al's case (1960).…”

Section: Discussionmentioning

confidence: 99%

“…from the pulmonary artery to the coronary artery, was commonly held until recently. Edwards (1958) and others (Abbott, 1927;Agustsson et al, 1962;Baffes, Ketola, and Tatooles, 1961;Case et al, 1958;Lampe and Verheugt, 1960;Sabiston, Neill, and Taussig, 1960) have recently presented evidence supporting Brooks' suggestion.We are presenting an angiocardiographic and catheter demonstration of flow from an anomalous left coronary artery into the pulmonary artery in a 4-year-old girl. …”

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confidence: 87%

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Anomalous Left Coronary Artery Arising From Pulmonary Artery

Ag¹,

Ellis²,

Or³

1963

Heart

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Origin of the left coronary artery from the pulmonary artery is an uncommon congenital cardiac anomaly. Brooks (1886) first suggested that blood flow in this condition was from the coronary artery into the pulmonary artery. Nevertheless, the view that blood flow is in the opposite direction, i.e. from the pulmonary artery to the coronary artery, was commonly held until recently. Edwards (1958) and others (Abbott, 1927;Agustsson et al., 1962;Baffes, Ketola, and Tatooles, 1961;Case et al., 1958;Lampe and Verheugt, 1960;Sabiston, Neill, and Taussig, 1960) have recently presented evidence supporting Brooks' suggestion.We are presenting an angiocardiographic and catheter demonstration of flow from an anomalous left coronary artery into the pulmonary artery in a 4-year-old girl. CASE REPORTThe patient, born in this hospital in 1956, by breech delivery after a normal pregnancy, weighed 2740 g. At the time of her birth, her mother was 32 years old and well, and her father was 38. There were three normal siblings and there had been one miscarriage. At birth, she suffered from asphyxia neonatorum and had a weak cry: oxygen and resuscitative measures were required. The patient developed normally but was noted to be a poor feeder from birth. At the age of 4 months, two weeks before her first admission, she began to wheeze and cough and these symptoms persisted to the time of admission.On admission, the heart was found to be enlarged to the left with the apical impulse in the 5th to 6th left intercostal space in the anterior-axillary line. A rough, grade III, systolic murmur was heard over the the entire prmcordium: it was loudest at the apex and was transmitted to the axilla. P2 was louder than A2. Coarse breath sounds and some scattered wheezes were heard bilaterally.Chest X-ray examination demonstrated a very large heart. Areas of pneumonia were present in both lung apices and the left lower lobe was atelectatic (Fig. IA).A cardiogram showed normal sinus rhythm, a mean electrical QRS axis of +300, inverted T waves in leads I, II, aVL, aVF and over the left prwcordium, a prominent R wave in the left prncordial leads, and a deep S in VI. The tracing was consistent with severe left ventricular enlargement.The patient was considered to have congenital heart disease complicated by congestive heart failure and pneumonia. The diagnostic considerations included fibro-elastosis, idiopathic myocarditis, anomalous coronary artery, and glycogen storage disease. There was some immediate improvement with achromycin, penicillin, and digitalis, but after two days of therapy, the infant appeared to be in extremis. Chloramphenicol, ACTH, and cortisone were added to try to reverse the apparent rapid deterioration, and there was great improvement: the steroids were discontinued at the end of a week. A chest radiogram taken just before discharge showed clearing of the lungs but no significant change in the heart size or contour.There were two more admissions during her first year because of failure to thrive and a respiratory infection whi...

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 87%

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Anomalous Left Coronary Artery Arising From Pulmonary Artery

Ag¹,

Ellis²,

Or³

1963

Heart

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“…It is now thought that different "types" of BWG syndrome do not exist; rather, there are only functional differences in "states". Agustsson et al [7] recognized that the L C X --* Fig. 3.…”

Section: Discussionmentioning

confidence: 99%

“…At first, BWG syndrome was classified into two functional types. The "infantile type" had a poor prognosis and over 80% of affected patients died in the first two years of life, while the "adult type" was associated with minor symptoms [4][5][6][7]. It is now thought that different "types" of BWG syndrome do not exist; rather, there are only functional differences in "states".…”

Section: Discussionmentioning

confidence: 99%

An adult case of Bland-White-Garland syndrome with collaterals from the bronchial artery

et al. 1994

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We report herein an adult case of anomalous origin of the left coronary artery from the pulmonary artery (Bland-White-Garland syndrome; BWG syndrome). The patient had chest discomfort during exercise and signs of mitral regurgitation. We diagnosed him as having BWG syndrome by angiography, and performed surgical treatment. At the operation, retrograde coronary blood flow was found through the left coronary artery during aortic cross-clamping. This suggested extracardiac anastomosis from peripheral arteries to the left coronary artery. Since the collateral blood flow was considerable during aortic cross-clamping, only the left coronary artery was closed. A collateral from the left bronchial artery to the left circumflex artery was demonstrated by postoperative angiography. Cases of adults with BWG syndrome are rare, and this may be the first report of a collateral from the bronchial artery.

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Demonstration of an anomalous connection between the left coronary artery and the pulmonary artery using a multislice CT 64

et al. 2008

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In this article, we describe two cases of anomalous connection of the left coronary artery. The first case is an infant of 4 years with an anomalous origin of the left anterior descending (LAD) artery and the diagonal branches and a circumflex artery which originated from the pulmonary artery. The second case is an adult of 50 years with the coronary artery originating from the pulmonary artery. Anomalous origin of the left coronary artery from the pulmonary artery is an uncommon congenital cardiac anomaly with an incidence of 0.25% among all congenital heart defects (Parale and Pawar [2006], J Assoc Physicians India 54:397-399). The originality of this communication consists in the use of a multislice CT scanner as a support for the angiography. The result is an original image with three dimensional details; in the case of the infant, it was determinant in the choice of the surgical approach.

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Anomalous Origin of Left Coronary Artery from Pulmonary Artery

Cited by 71 publications

References 16 publications

Anomalous Left Coronary Artery Arising From Pulmonary Artery

Anomalous Left Coronary Artery Arising From Pulmonary Artery

An adult case of Bland-White-Garland syndrome with collaterals from the bronchial artery

Demonstration of an anomalous connection between the left coronary artery and the pulmonary artery using a multislice CT 64

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