Surgical Outcome in Adolescents and Adults With Anomalous Left Coronary Artery From Pulmonary Artery

Yuan, Xin; Li, Bin; Sun, Hao; Yang, Yan; Meng, Hong; Xu, Liang; Song, Yue; Xu, Jianping

doi:10.1016/j.athoracsur.2018.05.051

Cited by 10 publications

(9 citation statements)

References 23 publications

(34 reference statements)

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“…The overwhelming majority of patients with ALCAPA fail to develop significant collateral circulation from the RCA to the LCA during their early infancy period, and more than 90% of patients will suffer severe heart failure and ultimately die within the first year of life if left untreated. Only 10% to 15% of patients develop significant collateral circulation and survive into adolescence or even adulthood with no or mild symptoms [ 6 ]. Nevertheless, it is often insufficient to supply the whole left ventricle through collateral vessels, resulting in chronic myocardial ischemia.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, it is often insufficient to supply the whole left ventricle through collateral vessels, resulting in chronic myocardial ischemia. As a result, 80–90% of these patients may develop malignant ventricular dysrhythmias, the majority of which occur within the first 3 decades of life [ 5 , 6 ]. In addition, they are at risk of developing silent myocardial infarction, left ventricular dysfunction and mitral insufficiency [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…Rarely, it is associated with other cardiac anomalies such as atrial septal defect, ventricular septal defect, aortic coarctation, tetralogy of Fallot or bicuspid aortic valve [ 4 , 5 ]. Only 10% to 15% of ALCAPA patients develop significant collateral circulation from the right coronary artery (RCA) to the left coronary artery (LCA) and survive into adolescence or even adulthood with no or mild symptoms[ 6 ]. Nonetheless, collateral vessels are often insufficient to supply the entire left ventricle, resulting in ischemic dysfunction/impairment of the papillary muscles and adjacent myocardium, and ultimately mitral valve prolapse [ 5 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Anomalous origin of the left coronary artery from the pulmonary artery as a rare cause of mitral valve prolapse: a case report

Wang

Xia

Huang

et al. 2022

BMC Cardiovasc Disord

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Background Mitral valve prolapse (MVP) is an etiologically heterogeneous disorder. Early diagnosis and prompt treatment of the underlying disease are of great significance. Herein, we present a rare case of MVP caused by anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). Case presentation A 22-year-old female presented with a 16-year history of anterior mitral leaflet prolapse. However, she had never experienced any discomfort before. At a routine follow-up, a transthoracic echocardiogram showed anterior mitral leaflet prolapse (A2) with moderate mitral regurgitation, and a retrograde blood flow from an extremely dilated left coronary artery (LCA). Further coronary angiography and coronary computed tomography angiography confirmed the diagnosis of ALCAPA. She subsequently underwent successful LCA reimplantation and concomitant mitral valve replacement. Intraoperatively, her mitral annulus was mildly dilated, anterior mitral valve leaflet appeared markedly thickened with rolled edges, and a chordae tendineae connecting the anterior leaflet (A2) was ruptured and markedly shortened. Conclusions ALCAPA is a rare and potentially life-threatening congenital coronary artery anomaly that may cause mitral valve prolapse. Echocardiogram is an important screening tool for this disorder.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Anomalous origin of the left coronary artery from the pulmonary artery as a rare cause of mitral valve prolapse: a case report

Wang

Xia

Huang

et al. 2022

BMC Cardiovasc Disord

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“… 6 , 7 The pathophysiological mechanism is ambiguous but may involve the long distance between anatomical structures, excessive extension or even distortion of the LCA, increased tissue stiffness, and metabolic disorders. 8 In fact, it has been hypothesized that the tractive force exerted on the LMCA after reimplantation and vascular rupture during an operation play the key role. 6 , 9 In the present case, pre-PCI IVUS demonstrated an attenuated plaque with a large plaque burden, suggesting that early atherosclerosis was accelerated after PCI and that any secondary preventive step may have been inadequate under the situation.…”

Section: Discussionmentioning

confidence: 99%

Intravascular ultrasound-guided stent implantation in reimplanted left main coronary artery of a 15-year-old child: a case report

Luo

Zheng

et al. 2022

European Heart Journal - Case Reports

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Background Only a few cases have been reported about clinical value of percutaneous coronary intervention and intravascular ultrasound (IVUS) in patients with stenosis of a re-implanted left main coronary artery (LMCA). Case summary We herein report a rare case of restenosis after direct reimplantation of an anomalous origin of the left coronary artery from the pulmonary artery in a 15-year-old girl. At the first evaluation, she had mildly reduced systolic dysfunction with left ventricular ejection fraction (EF) of 47%. Three months after surgical repair, the patient developed recurrent precordial pain. Consequent imaging tests and IVUS revealed a restenosis of the LMCA characterized as an attenuated plaque with a large plaque burden. A drug-eluting stent was implanted with IVUS guidance. Follow-up revealed a patent LMCA and preserved systolic function. Discussion The current case demonstrated that IVUS-guided percutaneous coronary intervention can be feasible in the treatment of coronary artery stenosis after repair of an anomalous origin of the left coronary artery from the pulmonary artery. Further study is needed to explore the pathophysiological mechanism of this condition and the clinical value of percutaneous coronary intervention and IVUS in patients with stenosis of the LMCA.

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“…Tedavi yaklaşımı sol koroner arterin doğrudan reimplantasyonunu içeren cerrahi onarım yapılmasıdır [8] . Asemptomatik ileri yaştaki hastalarda ender olarak konservatif medikal tedavi tercih edilebilir [9] .…”

Section: Discussionunclassified

Anesthesia Management in Alcapa Syndrome and The Use Of Intraoperative Transoesophageal Echocardiography

Şaylan¹,

Karadeniz²,

Paç³

et al. 2019

GKDA Derg

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ALCAPA (Anomalous origin of the left coronary artery from pulmonary artery) Sendromu (Bland-White-Garland Sendromu) anormal yerleşimli sol koroner arterin aorta yerine pulmoner arterden çıkışı ile karakterize, ender görülen bir konjenital koroner arter anomalisidir. Anestezi indüksiyonu ve idamesi pek çok nedenle özellik gösterir. Bu olgu sunumu ile sık rastlanmayan bu sendromda anestezi yönetiminin tartışılması ve intraoperatif transözofageal ekokardiyografi bulgularının paylaşılması, kullanımının önemine dikkat çekilmesi amaçlanmıştır.

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Surgical Outcome in Adolescents and Adults With Anomalous Left Coronary Artery From Pulmonary Artery

Cited by 10 publications

References 23 publications

Anomalous origin of the left coronary artery from the pulmonary artery as a rare cause of mitral valve prolapse: a case report

Anomalous origin of the left coronary artery from the pulmonary artery as a rare cause of mitral valve prolapse: a case report

Intravascular ultrasound-guided stent implantation in reimplanted left main coronary artery of a 15-year-old child: a case report

Anesthesia Management in Alcapa Syndrome and The Use Of Intraoperative Transoesophageal Echocardiography

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