Comprehensive literature review of anomalies of the coronary arteries

Harky, Amer; Noshirwani, Arish; Karadakhy, Ozhin; Ang, Juliana

doi:10.1111/jocs.14228

Cited by 24 publications

(34 citation statements)

References 64 publications

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“…Our experience with ALCAPA in adult patients is limited, as most of these are managed by cardiac surgeons for adults, and they usually perform coronary artery bypass surgery (CABG) with ligation of proximal left circumflex (LCX) coronary artery for such patients [15,16]. In our two adult patients, we could mobilise the coronary and could relocate it on aorta, using the trap door technique.…”

Section: Discussionmentioning

confidence: 99%

Surgical management of anomalous origin of coronary artery from pulmonary artery

Mishra

2021

Indian J Thorac Cardiovasc Surg

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Background Anomalous origin of coronary artery from pulmonary artery (AOCAPA), as is evident from the name, is defined as abnormal origin of either coronary artery from the pulmonary artery. The consequences vary in most cases and these anomalies lead to severe coronary hypo-perfusion and ventricular dysfunction. The common variants of this cardiac malformation are an anomalous origin of a left coronary artery from a pulmonary artery (ALCAPA) and anomalous origin of the right coronary artery from a pulmonary artery (ARCAPA). Another rare variant is left main coronary artery atresia that resembles ALCAPA in its mode of presentation. This article presents a single surgeon experience of managing this complex subset of the coronary anomaly from April 2006 to July 2019. Material and methods The 105 patients, who underwent surgery for AOCAPA from April 2006 to July 2019, have been included in the study. The patients have been analysed by follow-up echocardiography and electrocardiography (ECG) at our hospital by paediatric cardiologists. Out of 105 patients of AOCAPA, 98 (93.3%) patients underwent ALCAPA repair, of which 59 (60.2%) were males and 39 (39.7%) were females. Four out of five patients, who had an anomalous origin of the left coronary artery from the right pulmonary artery (ALCARPA), had an intramural aortic course. Three patients (3%) had left main coronary artery atresia and four patients (4%) had ARCAPA. It may be mentioned that seven infants (7.14%) and one adult patient (1%) underwent concomitant mitral valve repair. All the patients with ALCAPA, left main coronary artery atresia and ARCAPA, and 1 of the patients with ALCARPA, underwent coronary relocation. In four out of five patients with ALCARPA, unroofing of intraaortic intramural course was performed. Results Out of 105 patients of AOCAPA, 9 (8.5%) patients had in-hospital mortality. Five infants (5.0%) with ALCAPA and one patient (1%) with ALCARPA died in the post-operative period due to severe left ventricular dysfunction, mitral regurgitation (MR) and sepsis. One adult patient (1%) with ALCAPA, who underwent coronary relocation using in situ trap door technique and mitral valve (MV) repair, died due to massive intracranial bleeding. Two patients out of three (66.6%) with left main coronary atresia died in intensive care unit (ICU) after 3rd and 4th postoperative day, due to low cardiac output, severe ventricular dysfunction and severe MR. Patients were followed up for a median 5.9 years. Seven patients were lost to follow-up, including the sole survivor of left main coronary atresia, after a median follow-up of 4 years after surgery. Three patients underwent mitral valve replacement for progressive residual MR. There has been no late mortality. Conclusion AOCAPA is a rare congenital cardiac anomaly, which usually presents in infancy with left ventricular dysfunction and mitral valve regurgitation. Early diagnosis and surgical re-establishment of the dual coronary system has given gratifying results, with improvement in left ventricular function ...

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Section: Discussionmentioning

confidence: 99%

Surgical management of anomalous origin of coronary artery from pulmonary artery

Mishra

2021

Indian J Thorac Cardiovasc Surg

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“…There are three elements of coronary vasculature which are crucial to their development: (1) the sinusoids, (2) the vascular endothelial network, (3) the coronary buds on the aortic sinus. The coronary arteries develop within the atrioventricular and interventricular grooves with their proximal parts arising from the aortic valve sinuses [7]. There is a direct relationship between the distribution, the coronary size, and the extent of their dependant myocardium.…”

Section: Discussionmentioning

confidence: 99%

“…There is a direct relationship between the distribution, the coronary size, and the extent of their dependant myocardium. Abnormalities in the development of the coronary buds are implicated in coronary artery anomalies [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

A Widow-Maker and a Doppelganger: An Anomalous Case of the Coronaries

Malik

Zahid

Majedi

et al. 2020

Cureus

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“…Congenital anomalies of the coronary arteries are not uncommon and are non-fatal in most cases such as ectopic origin of the coronary arteries from the aortic sinus of Valsalva or separate ostia of the left coronary arteries [ 1 , 2 ]. However, attention should be paid to anomalies related to the left main coronary artery (LMCA) because it plays an essential role in providing blood supply to the majority of the left ventricle.…”

Section: Introductionmentioning

confidence: 99%

An Adult Case of Heart Failure due to Left Main Coronary Artery Atresia

et al. 2021

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Left main coronary artery (LMCA) atresia is a rare congenital heart disease and can be fatal in pediatric patients. We report an adult case of LMCA atresia, in which heart failure developed without episodes suggesting angina. A 40-year-old man presented with difficulty breathing. Echocardiography revealed diffuse hypokinesis of the left ventricle with an ejection fraction of 22% in the absence of significant valvular disease. A diagnosis of heart failure was made, and diuretics, enalapril, bisoprolol and warfarin were administered. Coronary angiography demonstrated no trace of the ostium of the LMCA in the sinuses of Valsalva; the middle to distal part of the LMCA was visualized by rich collateral flow from the right coronary artery to the left anterior descending coronary artery and left circumflex coronary artery. No trace of the ostium of the LMCA from the aorta or main pulmonary artery was detected on computed tomography angiography or echocardiography. The patient underwent coronary artery bypass grafting and a final diagnosis of congenital atresia of LMCA was made. The clinical course was uneventful and computed tomography angiography, performed 5 days after surgery, showed a patent bypass graft. This case demonstrates the importance of considering LMCA atresia even in the absence of chest symptoms suggesting angina in patients with heart failure.

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Comprehensive literature review of anomalies of the coronary arteries

Cited by 24 publications

References 64 publications

Surgical management of anomalous origin of coronary artery from pulmonary artery

Surgical management of anomalous origin of coronary artery from pulmonary artery

A Widow-Maker and a Doppelganger: An Anomalous Case of the Coronaries

An Adult Case of Heart Failure due to Left Main Coronary Artery Atresia

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