Intraoperative Diagnosis of ALCAPA Complicating an Aortopulmonary Window Repair

Abstract

We present the case of transient left ventricular dysfunction secondary to impaired left coronary artery filling after aortopulmonary window repair, caused by intraoperative diagnosis of anomalous left coronary artery from pulmonary artery. Immediate recognition and repair allowed for uneventful recovery of the patient.

Comment on Aortopulmonary Window and Anomalies of Coronary Arterial Origin

“…We thank Professor Anderson for his comments on our paper wherein we discussed the challenges faced during the management of a patient with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) associated with aortopulmonary window (APW). 1 As acknowledged in our report, a handful of cases with a similar combination are available in literature. In addition, Prof Anderson proposes, based on his relentless observations, that there might be an embryologic plausibility for the occurrence of coronary arterial malformation in hearts with persistent aortopulmonary foramen.…”

“…In 2 recent case reports published in the journal, attention has been drawn to the association between an aortopulmonary window and anomalous origin of the left coronary artery from the pulmonary trunk. 1,2 In the manuscript recently listed as an “online first,” Arvind et al 2 go so far as to suggest that their observation of this combination is “unique.” This seems somewhat of an exaggeration since in the text they cite the earlier report. 1 This report itself acknowledged the previous account provided by Alhadlaq et al, 3 which revealed the presence of at least 11 known cases.…”

Unique Association of Aortopulmonary Window With Anomalous Origin of Left Coronary Artery From Pulmonary Artery in an Infant: A Blessing in Disguise?

“…Failure to identify and correct this coronary anomaly during surgery for associated lesions would result in unforeseen postoperative ventricular dysfunction. 3,4…”

“…Since the first report by Bourlon et al only 12 patients have been reported in literature with this unusual combination of APW and ALCAPA. [2][3][4] Of these, preoperative identification of ALCAPA was accomplished in one patient only, suggesting the challenges in Submitted August 20, 2021; Accepted October 28, 2021.…”

“…Failure to identify and correct this coronary anomaly during surgery for associated lesions would result in unforeseen postoperative ventricular dysfunction. 3,4 ALCAPA is characterized by formation of extensive collaterals between the right and left coronary systems. This helps supply blood from RCA (which receives normally saturated blood at systemic pressures) to the territories supplied by LCA (which receives desaturated blood at lower pressures).…”