The Problem of the Anomalous Left Coronary Artery Arising from the Pulmonary Artery in Older Children

Liebman, Jerome; Hellerstein, Herman K.; Ankeney, Jay L.; Tucker, A.

doi:10.1056/nejm196309052691002

Cited by 45 publications

(10 citation statements)

References 18 publications

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“…About 87% of the patients present in infancy (Neufeld, 1983) and of these 65% to 85% die before one year of age due to congestive heart failure and infarction (Wesselhoeft et al, 1968). It is noted that if the children improve spontaneously (Liebman et al, 1963), it might be from formation of extensive collaterals or there could be ostial stenosis at the entry of the anomalous coronary into the pulmonary artery, thus conferring slight protection. However, they are still at high risk of sudden cardiac death with exercise (Fontana, 1962).…”

Section: Wwwintechopencommentioning

confidence: 99%

Cardiac Vasculature: Development and Pathology

Watanabe¹,

Wikenheiser²,

Ramírez-Bergeron³

et al. 2011

Vasculogenesis and Angiogenesis - From Embryonic Development to Regenerative Medicine

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Section: Wwwintechopencommentioning

confidence: 99%

Cardiac Vasculature: Development and Pathology

Watanabe¹,

Wikenheiser²,

Ramírez-Bergeron³

et al. 2011

Vasculogenesis and Angiogenesis - From Embryonic Development to Regenerative Medicine

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“…Since the left aortic sinus of Valsalva is in closer proximity to the septum of the truncus than to the right sinus [3], a far smaller displacement of the left coronary artery anlage will cause the left coronary artery ostium to fall within the pulmonary artery . Abrikossoff's theory, however, fails to explain those cases in which an accessory (third) coronary artery [6,27], or only one branch of the left coronary artery [1, 12,14,30,40,44], arises from the pulmonary artery . The theory also fails to explain why the relative size of the pulmonary artery, aorta, and their valves has not been found to be altered by displacement of the septum .…”

Section: Discussion Clinical Featuresmentioning

confidence: 99%

“…Rarer varieties of partial origin of the coronary arterial system from the pulmonary artery (PA) include origin of an accessory (third) artery from the PA, while the right and left coronary arteries arise normally from the aorta [6,27], origin of the left anterior descending coronary artery from the PA [14,40,44], and origin of the left circumflex coronary artery from the PA [4,30] . TCAPA is the rarest with only 21 cases having been previously reported (Tables I and 2) .…”

mentioning

confidence: 99%

Total anomalous origin of the coronary arteries from the pulmonary artery

et al. 1986

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The clinicopathologic features of four patients with total anomalous origin of the coronary arteries from the pulmonary artery (TCAPA) are presented and compared with 21 previously reported cases. Patients with TCAPA usually present with left ventricular heart failure, angina, or associated cardiovascular anomalies. Of the 19 patients in whom a clinical history was available, 16 were symptomatic before three days of age. All patients died with 60% dying before two weeks of age. Longer survival was associated with additional cardiovascular anomalies that increased pulmonary arterial perfusion pressure, oxygen saturation, or both. Seventeen (68%) patients had additional cardiovascular anomalies, most commonly atrial (nine cases) or ventricular (eight cases) septal defects and tetralogy of Fallot or other variants of pulmonary atresia (four cases). Only five (22%) of 23 had noncardiovascular anomalies. The coronary arteries arose equally from either one ostium or from two, and the number of ostia was not related to either anomalous coronary artery distribution or to the presence of additional cardiovascular anomalies. Cardiomegaly was present in 56% of cases and the majority of patients had myocardial fibrosis or infarction. Embryology is reviewed and evidence is presented to support the theory of involution-persistence of coronary artery anlagen as the pathogenetic mechanism of TCAPA.

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“…However in ALADPA, there are not much of modalities reported. [10][11][12][13] Ligation of the anomalous artery or connecting it to the aorta has been recommended. 14 Early surgical intervention has been found to have significantly improved outcomes.…”

Section: Case Reportmentioning

confidence: 99%