Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery in Adulthood: Challenges and Outcomes

Kothari, Jignesh; Lakhia, Ketav; Solanki, Parth; Parmar, Divyakant; Boraniya, Hiren; Patel, Sanjay

doi:10.5090/kjtcs.2016.49.5.383

Cited by 10 publications

(17 citation statements)

References 7 publications

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“…[ 2 ] It is speculated occurring from either an abnormal septation of the conus arteriosus or from the persistence of the pulmonary buds combined with involution of the aortic buds that form the coronary arteries. [ 5 ] The prognosis of this syndrome depends on early diagnosis and successful cardiac surgery. The preferred method is a direct reimplantation of the left coronary artery (LCA) to the aorta.…”

Section: Introductionmentioning

confidence: 99%

Misdiagnosed anomalous left coronary artery from the pulmonary artery as endocardial fibroelastosis in infancy

et al. 2017

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Introduction:Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare but severe congenital cardiac malformation. The prognosis mainly depends on the early and accurate diagnosis and treatment. However, without a typical and specific clinical manifestation in early stage, ALCAPA has a higher rate of false initial diagnosis.Diagnostic and therapeutic procedure:Three infants with impaired left ventricle (LV) function, LV enlargement, mitral valve regurgitation (MR), and LV endocardium thickness were initially diagnosed as endocardial fibroelastosis (EFE). Due to the treatment effectiveness with prednisone acetate and digoxin, abnormal Q waves with T inversion, and dilated right coronary artery (RCA), the diagnosis of ALCAPA was suspected. Lastly, cardiac angiography confirmed the diagnosis. All of them were transferred to the cardiac surgery department and received a successful surgical repair. The follow-up results showed that abnormal Q waves with T waves inversion on electrocardiogram gradually regressed and disappeared, LV ejection fraction and LV dilation returned to a normal range after surgery, with alleviation of MR. Besides, endocardial thickness secondary to ischemia also returned to normal.Conclusion:ALCAPA should be suspected when confronted with patients with left heart enlargement, impaired left ventricular function, and signs of myocardial ischemia, particularly in infancy. EFE is an important differential diagnosis and may also arise as a result of ALCAPA. Abnormal Q waves with T waves inversion, particularly in avL, dilated RCA and increased ratio of RCA/AO are important differential key points for the identification of ALCAPA and EFE. Awareness of this condition is essential for prompt recognition and referral to a tertiary cardiac center to enable early surgical intervention and improved prognosis for these children.

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Section: Introductionmentioning

confidence: 99%

Misdiagnosed anomalous left coronary artery from the pulmonary artery as endocardial fibroelastosis in infancy

et al. 2017

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“…The reimplantation surgery, which is the ideal option to achieve a definitive two-coronary anatomy and physiology, has become the first-choice procedure for this anomaly with favorable short and long-term outcomes. [5,6] Our patient was diagnosed with adult form of ALCAPA syndrome. There was no pathological Q wave or T wave inversion on ECG.…”

Section: Discussionmentioning

confidence: 87%

ALCAPA syndrome in an asymptomatic young soccer player

Ramoğlu

Bulut

Epçaçan

et al. 2019

Turk Gogus Kalp Dama

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Pulmoner arterden kaynaklanan sol koroner arter anomalisi sendromu nadir, ama ciddi bir doğuştan kalp anomalisidir. Bebeklik döneminde dilate kardiyomiyopatinin ve sol kalp yetmezliğinin önemli bir nedeni olup, tedavi edilmez ise, prognozu kötüdür ve genel mortalitesi %90'ın üzerindedir. Hastaların yaklaşık %15'i kollateral dolaşım gelişimine bağlı olarak bir yaşından sonra hayatta kalabilir ve bu hastalarda göğüs ağrısı, nefes darlığı, senkop ve aritmiler görülebilir. Bazı olgularda miyokard enfarktüsü ve ani kardiyak ölüm ilk ve tek semptom olabilir. Bu sendromun tedavisi acil cerrahi düzeltme olup, uzun dönem sonuçları iyidir. Bu yazıda, pulmoner arterden kaynaklanan sol koroner arter anomalisi tanısı konulan ve başarılı bir cerrahi yapılan asemptomatik ergen aktif bir sporcu sunuldu.

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“…Echocardiography aids in diagnosis, notably in pediatric patients and young adults, because it allows the direct visualization of the abnormal origin of the LCA, dilated RCA, retrograde filling of the anomalous coronary artery, abnormal diastolic flow in the pulmonary artery, and abnormal septal or epicardial color flow signals from the collateral vessels [ 6 , 7 ]. In our patient, the quality of the echocardiographic images was suboptimal owing to overweight and poor acoustic window: Neither the anomalous ostium of the LCA nor the course of the RCA was noticeable.…”

Section: Discussionmentioning

confidence: 99%

An unusual presentation of anomalous left coronary artery from the pulmonary artery (ALCAPA) syndrome in a 70-year-old man: a case report

et al. 2018

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BackgroundWe present a rare case of anomalous origin of the left coronary artery from the pulmonary artery syndrome in an elderly man, and we describe coronary computed tomographic angiographic imaging findings to improve diagnostic confidence for the evaluation of this uncommon coronary artery anomaly.Case presentationA 70-year-old Caucasian man came to our hospital with slight limitation of physical activity (New York Heart Association class II). He was asymptomatic for angina, syncope, and palpitations. Cardiac magnetic resonance imaging was performed after echocardiography because a hypertrophic cardiomyopathy was suspected; a plausible coronary artery anomaly was demonstrated as collateral evidence. Subsequently, coronary computed tomographic angiography showed the anomalous origin of left coronary artery from the pulmonary artery; the coronary vessels appeared markedly dilated and tortuous. Dilated intercoronary vessels along the epicardial surface of the heart and dilated bronchial arteries, corresponding to collateral pathways, were observed. Left ventricular hypertrophy, delayed subendocardial enhancement, and mitral insufficiency were better evaluated on magnetic resonance images. Invasive coronary angiography confirmed the main findings. Given the patient’s age and clinical performance, surveillance with medical management was considered appropriate, and surgical repair was avoided.ConclusionsConfidence with the anatomic pattern and clinical significance of this anomalous condition is necessary to improve cardiac imaging evaluation ability. In our patient, coronary computed tomographic angiography proved to be a reliable imaging approach, superior to invasive coronary angiography in terms of diagnostic performance and patient safety.

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Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery in Adulthood: Challenges and Outcomes

Cited by 10 publications

References 7 publications

Misdiagnosed anomalous left coronary artery from the pulmonary artery as endocardial fibroelastosis in infancy

Misdiagnosed anomalous left coronary artery from the pulmonary artery as endocardial fibroelastosis in infancy

ALCAPA syndrome in an asymptomatic young soccer player

An unusual presentation of anomalous left coronary artery from the pulmonary artery (ALCAPA) syndrome in a 70-year-old man: a case report

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