Noninvasive Doppler color flow mapping for detection of anomalous origin of the left coronary artery from the pulmonary artery and for evaluation of surgical repair

Abstract

Anomalous origin of the left coronary artery from the pulmonary artery is a rare but important cause of congestive heart failure in infancy and of sudden death at all ages. Diagnosis is often missed when based solely on physical examination and noninvasive methods. A 4 year old patient is presented in whom mitral regurgitation was noted by a referring physician and an anomalous left coronary artery was found by Doppler color flow mapping upon referral and verified at cardiac catheterization. Doppler color flow mapping was also used intraoperatively using a gas-sterilized transducer to further clarify the hemodynamics and assess the surgical result. After creation of an intrapulmonary artery tunnel from the ostium of the left coronary artery to the aorta, anterograde coronary artery flow and absence of a residual left to right pulmonary artery shunt were verified during surgery by Doppler flow mapping. Postoperatively, residual mitral regurgitation and patency of the left coronary artery graft have been followed up serially by Doppler flow mapping. Therefore, Doppler color flow mapping is useful in the diagnosis and intraoperative and postoperative management of this important and potentially life-threatening abnormality.

Anomalous Left Coronary Artery from Non-Facing Pulmonary Sinus

“…Based on preoperative imaging, which included the combined use of color-fl ow mapping and pulsed Doppler, the anomalous LCA originating from the non-facing pulmonary sinus was identifi ed. 7 The geometric analysis was performed based on the interrelationship of the orifi ce and the mobile cusps of the pulmonary valve and its commissures, especially on both sides of the non-facing sinus. When an anomalous coronary ostium is located at the most distal position from the aorta, the Takeuchi procedure is considered to be a useful surgical technique in such a rare case.…”

Anomalous origin of the left coronary artery from the pulmonary artery in infancy with preserved left ventricular function: Potential pitfalls and clues to diagnosis

“…The classical echocardiographic finding in the diagnosis of anomalous left coronary artery is demonstration of the ALCAPA by two-dimensional echocardiography. [ 3 4 ] Demonstration of color Doppler flow reversal in proximal left coronary artery is considered crucial because errors may result if two-dimensional echocardiographic images are used in isolation. [ 4 ] While pulmonary hypertension allows preservation of ventricular function, it may make echocardiographic diagnosis difficult.…”

“…[ 3 4 ] Demonstration of color Doppler flow reversal in proximal left coronary artery is considered crucial because errors may result if two-dimensional echocardiographic images are used in isolation. [ 4 ] While pulmonary hypertension allows preservation of ventricular function, it may make echocardiographic diagnosis difficult. The increased echogenecity of anterior-lateral papillary muscle and adjacent myocardium on echocardiography is a useful pointer to the diagnosis in this situation.…”

“…This involves demonstration of the origin of the left coronary artery from pulmonary artery together with reversed flow in the left coronary artery and its main divisions. [ 3 4 ] Occasionally, the disease escapes detection during infancy and is diagnosed much later in life. In these older patients the ventricular function tends to be preserved through extensive collateral supply from the right coronary artery branches.…”

Anomalous Origin of the Left Anterior Descending Artery from the Pulmonary Artery

“…On histologic examination of the wall of the anomalous vessels, the media, while thin, still resembled that of an artery. 13 These findings suggest that the anomalous LAD, exposed to low pressures over a long period of time, will probably never totally recover from the preoperative dilatation and aneurysmal changes.…”