Echocardiographic diagnosis of anomalous origin of the left coronary artery from the pulmonary artery

Yuan, Xinchun; Hu, Jia; Zeng, Xi; Aiyun, Zhou; Chen, Li

doi:10.1097/md.0000000000018046

Cited by 10 publications

(15 citation statements)

References 24 publications

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“…Figure 1) Although mitral regurgitation was present in all of our patients, its intensity was not as severe as mentioned in other series. Unlike infant population, prominent papillary muscles are less often observed in adults 8 and none of the four presented patients had this finding in our report.…”

Section: Psax Substernal Tee Transgastric Viewcontrasting

confidence: 60%

“…A good correlation has been reported between the location of this collaterals in echocardiography with their course in coronary catheterization. 8 The dilated origin of RCA from aorta is another notable clue, and there have been reports which suggest that increased ratio of RCA to aorta diameters (more than 0.2) can be a useful measure in diagnosis of patients with ALCAPA (Figure 3). 8 The patients often have some degree of LV systolic dysfunction with RWMA more prominent in territory of LAD and LCX.…”

Section: Echocardiographic Measuresmentioning

confidence: 99%

“…8 The dilated origin of RCA from aorta is another notable clue, and there have been reports which suggest that increased ratio of RCA to aorta diameters (more than 0.2) can be a useful measure in diagnosis of patients with ALCAPA (Figure 3). 8 The patients often have some degree of LV systolic dysfunction with RWMA more prominent in territory of LAD and LCX. This nonspecific finding can be enlightening when considered besides other evidences.…”

Section: Echocardiographic Measuresmentioning

confidence: 99%

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The role of echocardiography in anomalous origin of coronary artery from pulmonary artery (ALCAPA): Simple tool for a complex diagnosis

et al. 2019

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Anomalous origin of coronary artery from pulmonary artery (ALCAPA) is a rare coronary anomaly usually presenting in the first year of life. Adult presentation suggests a wide range of differential diagnosis such as myocarditis, dilated cardiomyopathy, and coronary artery disease. We have presented here the major distinctive echocardiographic features of ALCAPA through 4 cases. Since echocardiography is often used as the first imaging modality in these clinical scenarios, recognizing the characteristics of ALCAPA in a routine echocardiographic examination can transform a readily available, low‐cost tool into a valuable discriminative modality.

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Section: Psax Substernal Tee Transgastric Viewcontrasting

confidence: 60%

Section: Echocardiographic Measuresmentioning

confidence: 99%

Section: Echocardiographic Measuresmentioning

confidence: 99%

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The role of echocardiography in anomalous origin of coronary artery from pulmonary artery (ALCAPA): Simple tool for a complex diagnosis

et al. 2019

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“…For suspected ALCAPA syndrome, there are two main modalities used for diagnosis: transthoracic echocardiography (TTE) and CCTA. Based on a small retrospective study involving 11 patients with ALCAPA confirmed by surgery, there was no statistical difference between TTE and CTA for diagnosing ALCAPA (p > 0.05) [ 8 ]. The confirmation of ALCAPA syndrome requires three caveats for diagnosis with imaging modalities:…”

Section: Discussionmentioning

confidence: 99%

Adult Anomalous Left Coronary Artery Arising From the Pulmonary Artery (ALCAPA) Syndrome as First Presentation With Atrial Fibrillation in a Marathon Runner

Alsamman¹,

Tuna²,

Dunn³

et al. 2021

Cureus

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Anomalous left coronary artery arising from the pulmonary artery (ALCAPA) syndrome is a very rare congenital heart disease with an incidence of one in 300,000 and a high rate of mortality early in life if left untreated. Adult-type ALCAPA presents when significant collaterals develop from the right coronary artery (RCA) to the left coronary artery (LCA). Even with the collaterals, chronic sub-endocardial ischemia occurs in most cases, and patients die from sudden cardiac death.Here we present a case of a 38-year-old female who lived an active and healthy life and presented with chest pain and palpitations. Initial electrocardiography (EKG) showed atrial fibrillation with rapid ventricular response. Although initial cardiac enzymes were negative and there were no ischemic EKG changes, troponins became elevated over the course of the hospital stay and the patient underwent a left heart catheterization. Results revealed a dilated RCA extending to the left ventricle and an anomalous left main originating from the pulmonary artery with complete occlusion. The patient received medical management for acute coronary syndrome, including heparin infusion for 48 hours, aspirin, metoprolol, and atorvastatin. She was referred to a tertiary care facility for surgical correction of anomaly of the coronary arteries. The next day, the patient arrived in the emergency department with an acute onset of speech difficulty and leftsided weakness. A brain CT without contrast showed hematoma in the right frontal lobe. The patient underwent surgical evacuation of the hematoma with marked improvement of her weakness. The patient recovered after a successful surgical repair involving translocation of the left main coronary artery to the aorta.It has been reported that ALCAPA should be considered in a young adult with dilated cardiomyopathy and mitral regurgitation (MR). Other common presentations include acute myocardial infarction, angina, and dyspnea on exertion. Sudden cardiac death is not uncommon; however, it tends to decrease with age of diagnosis. Interestingly, our patient was known to have MR with regular follow-up at the cardiology clinic for years. Echocardiogram never showed any abnormalities other than MR. She never received further workup to address the reason of MR, although she has no underlying chronic conditions that can explain it. In relatively young patients with a healthy lifestyle presenting with chest pain, a broader look at etiologies should be considered. We would like to emphasize the importance of looking up for possible coronary artery disease, especially in young individuals.

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“…Transthoracic echocardiography is the first-line examination and guides the diagnosis by showing an increased echodensity of the endocardium [ 7 ]. Localization is variable and can involve the papillary muscles that may appear hypertrophied [ 8 , 9 ]. Cardiac MRI is the reference test and looks for late gadolinium enhancement that may also involve the mitral papillary muscle [ 10 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

Anomalous Left Coronary Artery Connected to the Pulmonary Artery in a 15-Year-Old Girl: Case Report and Discussion on Secondary Prevention of Sudden Death

Laïk¹,

Fouilloux

Aldebert

et al. 2021

Case Reports in Cardiology

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Background. Anomalous left coronary artery connected to the pulmonary artery (ALCAPA) is a rare congenital heart disease. Adaptive development of sufficient heterocoronary collaterality in the newborn may allow survival to a later age. In older children or adults, malignant ventricular arrhythmias can reveal the disease. Case Report. A 15-year-old girl was referred to the local hospital after a resuscitated out-of-hospital cardiac arrest. CT scan and coronary angiography revealed an ALCAPA. Direct aortic reimplantation of the left coronary artery was performed. Postoperative ECG monitoring showed short episodes of nonsustained ventricular tachycardia. Transthoracic echocardiography and cardiac MRI revealed subendocardial fibrosis of the anterolateral papillary muscle. Beta-blockade therapy was initiated at first intention. After hospital discharge, the patient reported several fainting without loss of consciousness. Considering sudden death nonrelated to effort, episodes of nonsustained ventricular tachycardia, and areas of myocardial fibrosis, the patient underwent subcutaneous cardioverter-defibrillator implantation. 6-month follow-up is satisfactory without clinical or rhythmic abnormalities. Discussion. Indication for surgical correction of ALCAPA is well defined, but rhythmic secondary prevention after resuscitated cardiac arrest is less consensual. Cardiac MRI is an essential tool in the identification of a potential rhythmic substrate and should be taken into account in the discussion of a preventive cardioverter-defibrillator implantation.

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Echocardiographic diagnosis of anomalous origin of the left coronary artery from the pulmonary artery

Cited by 10 publications

References 24 publications

The role of echocardiography in anomalous origin of coronary artery from pulmonary artery (ALCAPA): Simple tool for a complex diagnosis

The role of echocardiography in anomalous origin of coronary artery from pulmonary artery (ALCAPA): Simple tool for a complex diagnosis

Adult Anomalous Left Coronary Artery Arising From the Pulmonary Artery (ALCAPA) Syndrome as First Presentation With Atrial Fibrillation in a Marathon Runner

Anomalous Left Coronary Artery Connected to the Pulmonary Artery in a 15-Year-Old Girl: Case Report and Discussion on Secondary Prevention of Sudden Death

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