Surgical Treatment for Anomalous Origin of Left Coronary Artery from Pulmonary Artery

Chiariello, Luigi; Meyer, Joseph; Reul, George J.; Hallman, Grady L.; Cooley, Denton A.

doi:10.1016/s0003-4975(10)64046-5

Cited by 45 publications

(6 citation statements)

References 19 publications

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“…Saphenous vein grafting has a better patency rate in ALCAPA repair (80% after 14 years) than in atherosclerotic coronary artery disease. 14 One of the 2 patients who had ALCAPA repair with a saphenous vein graft died on the 8th postoperative day, but the other is asymptomatic after 16 years. Nevertheless, the use of saphenous vein for ALCAPA repair is unpopular because of questionable conduit patency due to intimal hyperplasia.…”

Section: Discussionmentioning

confidence: 98%

Evolution of Surgical Strategies for Anomalous Left Coronary Artery

Mohanty

Murthy

Varghese

et al. 2001

Asian Cardiovasc Thorac Ann

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Between 1980 and 2000, 18 patients aged 3 months to 60 years underwent repair of an anomalous left coronary artery from the pulmonary artery. Up to 1993, 8 patients were managed by subclavian artery turndown (4), coronary artery revascularization with ligation of the anomalous left coronary artery (3), or ligation of the anomalous left coronary artery alone (1). From 1994(1). From to 1999 patients underwent Takeuchi's repair. Great arterial wall tube interposition was used in the latest 4 patients. Concomitant mitral valve procedures were required in 4 patients. There were 3 early postoperative deaths (16.7%), and 1 patient who underwent subclavian artery turndown and mitral valve replacement died of bacterial endocarditis 3 months postoperatively. One patient had a tunnel leak at 6 months postoperatively, which was closed successfully; another developed significant right ventricular outflow obstruction and is awaiting surgery. Early two-coronary repair using the great arterial wall tube interposition technique looks promising.

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Section: Discussionmentioning

confidence: 98%

Evolution of Surgical Strategies for Anomalous Left Coronary Artery

Mohanty

Murthy

Varghese

et al. 2001

Asian Cardiovasc Thorac Ann

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“…Several procedures have been used for repair in BWG syndrome, including ligation of the LMCA as a one-coronary-system repair [7], anastomosis directly to the aorta [8], anastomosis of imposed subclavian artery to the aorta [9], and the LCA bypass as a twocoronary-system repair [10]. Nowadays, simple ligation of the LMCA is not recommended because of high mortality, and coronary artery bypass has a risk of deficiency of blood supply to the enlarged coronary artery.…”

Section: Discussionmentioning

confidence: 99%

Two adult cases of Bland–White–Garland syndrome with lethal arrhythmia due to coronary steal phenomenon during physical or mental stress

Taniai

Takemoto

Nagai

et al. 2016

Journal of Cardiology Cases

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IntroductionAnomalous origin of the left coronary artery from the pulmonary artery (ACLAPA) is widely called BWG syndrome, and was first reported by Bland, White, and Garland in 1933 [1]. This is a rare congenital heart disease with prevalence of one in 300,000 births or 0.25-0.5% of all congenital heart disease [2]. The left main coronary artery (LMCA) originates from the main pulmonary artery in more than 90% of cases of BWG syndrome. We herein report two notable adult BWG syndrome cases that presented with ventricular tachycardia (VT) during exertion in daily life, and recovered well with cardiopulmonary resuscitation (CPR) by appropriate use of an automated external defibrillator (AED). Case 1A 42-year-old man suddenly collapsed while jogging. Consciousness level was Glasgow Coma Scale (GCS) 1-1-1 at the time the rescue team arrived, and bystander CPR had been performed until then. The electrocardiographic (ECG) monitor showed VT and ventricular fibrillation (VF) when the AED was attached. The AED was operated 7 min after the patient collapsed. ECG showed normal sinus rhythm with ST depression in the chest leads on arrival at our hospital.After administration of amiodarone, VT did not reoccur during the course of admission. Multi-detector computed tomography coronary angiography (CTA) was performed because of suspected ischemic arrhythmia, and showed that the left coronary artery (LCA) originated from the pulmonary artery with marked collateral flow from the right coronary artery (RCA) to the LCA, consistent with BWG syndrome (Fig. 1a).Invasive coronary angiography (CAG) showed that the RCA and conus branch were well developed and provided good collateral flow to the left anterior descending artery and left circumflex Journal of Cardiology Cases xxx (2016) xxx-xxx Anomalous origin of left coronary artery from pulmonary artery Ventricular tachycardia Congenital A B S T R A C TWe experienced two adult cases of anomalous origin of the left coronary artery from the pulmonary artery, so-called Bland-White-Garland (BWG) syndrome, that presented with ventricular tachycardia (VT) and ventricular fibrillation during exertion in daily life. They presented to our hospital with syncope due to VT, and recovered following application of an automated external defibrillator with cardiopulmonary resuscitation. We diagnosed BWG syndrome by multi-detector computed tomography angiography and coronary angiography. We analyzed the mechanisms of lethal arrhythmias in relation to myocardial ischemia on exertion. Coronary flow modification and implantable cardioverter defibrillator implantation were performed in order to prevent future lethal arrhythmia due to myocardial ischemia. It is important to be aware of congenital heart disease in ordinary cases.

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“…If sufficient collateral blood supply from the right coronary artery is present, the patient may have minimal symptoms in infancy, and can be managed successfully at an older age either by ligating the anomalous artery at its origin [7,12] or by providing it with direct blood supply [2,12] . On the other hand, if collaterals are not adequate, the patient becomes symptomatic early in infancy when pulmonary vascular resistance and pulmonary artery pressure decrease .…”

Section: Discussionmentioning

confidence: 99%

“…Among the different revascularization procedures used, direct aortic implantation of the anomalous origin of the left coronary artery is limited in use to patients with an adequate length of the anomalous artery such that it would allow mobilization and anastomosis to the aorta without kinking or tension . Aortocoronary anastomosis using saphenous vein or subclavian artery free grafts is not a better alternative because of the small size, limited growth potential, fibrous intimal hyperplasia, and poor long-term patency of the free grafts [2,3] . On the other hand, direct left subclavian-coronary artery anastomosis offers the following advantages : it avoids the use of cardiopulmonary bypass in these critically ill patients, involves performing only one 38 anastomosis, and utilizes well-vascularized tissue that allows growth of the vessel and the anastomosis [10] .…”

Section: Discussionmentioning

confidence: 99%

Surgical management of anomalous left coronary artery with mitral insufficiency in infancy: Contribution of echocardiography

et al. 1984

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A 6-month-old infant with anomalous left coronary artery underwent a direct left subclavian-left coronary artery anastomosis without the use of cardiopulmonary bypass. Subsequently, mitral valve replacement was performed for severe mitral insufficiency diagnosed echocardiographically to be due to isolated papillary muscle infarction. To our knowledge, this is the youngest patient to have undergone both procedures during the first year of life with excellent results on follow-up studies. The case demonstrates the advantages of using direct subclavian-coronary artery anastomosis and 2-dimensional echocardiography in the management of patients with anomalous left coronary artery.

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Surgical Treatment for Anomalous Origin of Left Coronary Artery from Pulmonary Artery

Cited by 45 publications

References 19 publications

Evolution of Surgical Strategies for Anomalous Left Coronary Artery

Evolution of Surgical Strategies for Anomalous Left Coronary Artery

Two adult cases of Bland–White–Garland syndrome with lethal arrhythmia due to coronary steal phenomenon during physical or mental stress

Surgical management of anomalous left coronary artery with mitral insufficiency in infancy: Contribution of echocardiography

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