Anomalous origin of the left coronary artery from the right pulmonary artery: Report of a case

Summary A 1-year-old boy was referred to our hospital for further investigation of mitral regurgitation. Color-Doppler echocardiography revealed the site of the anomalous origin of the left coronary artery which was confirmed by a cineangiographic study. This case is interesting for several reasons: the first is that the anomalous left coronary artery originated from the right pulmonary artery; the second is that two-dimensional echocardiographic findings can be misleading, i.e., a vessel-like structure which seemed to be the left coronary artery arising normally from the aorta was visualized; and the last is that a two-dimensional color-Doppler echocardiogram was useful in the diagnosis of the anomalous origin of the left coronary artery. The patient underwent implantation of the anomalous left coronary artery as well as Kay's plasty of the mitral valve, and has been doing well since then.     

Anomalous origin of the right coronary artery from the pulmonary artery. Two case reports

Anomalous origin of the right coronary artery originating from the pulmonary trunk (ARCAPA) is a rare but potentially fatal anomaly. We are presenting two cases of ARCAPA and reviewing the main previous published data on this lesion. The first patient presented at the age of 5 months with respiratory distress and severe chest infection. He was found to have heart murmur and cardiomegaly on chest X ray. Echocardiographic and angiographic data confirmed an ARCAPA associated to a large malalignment ventricular septal defect and distal pulmonary artery aneurysms. He underwent surgical closure of the ventricular septal defect and reimplantation of the ARCAPA on the aorta with good result.The second case is an 11 year old male patient, complaining of dizziness and chest pain on exertion. Echocardiographic and angiographic data confirmed ARCAPA associated to a valvular pulmonary stenosis. He was operated on successfully. He got also direct reimplantation of the anomalous coronary artery on the aorta and a pulmonary valve commissurotomy. An anomalous origin of the right coronary artery is a rare condition but may lead to myocardial ischemia and sudden death. Diagnosis is mainly made by echocardiography and confirmed by conventional coronary arteriography. Operative correction is the appropriate treatment for an anomalous coronary artery arising from the pulmonary trunk.     

Anomalous origin of left coronary artery from pulmonary artery.

An anomalous origin of the left coronary artery from the pulmonary artery in a 26-year-old man was corrected by the ligation of the artery at its anomalous origin, followed by the construction of an aortocoronary bypass with a venous graft. The flow of blood to the myocardium was measured for the purpose of comparing the effect of the bypass method with that of the ligation method. The result suggested that the bypass method provided a greater flow of blood to the myocardium than did ligation alone.     

Anomalous origin of the right coronary artery from the main pulmonary artery. Report of the case (author's transl)]

A case of anomalous origin of the right coronary artery from the main pulmonary artery in a 22 y.o. female is reported. The patient underwent successfully surgical correction by reimplantation of the anomalous vessel to the ascending aorta. The literature has been reviewed; the clinical features, the surgical approach and technique are described.     

Anomalous origin of left coronary artery in pulmonary artery]

We report 2 infants aged 6 months and one year with an anomalous left coronary artery origin treated surgically at our centre with direct aortic reimplantation of the anomalous coronary. Evolution has been satisfactory, with a great improvement of ventricular function. The mitral incompetence and congestive heart failure have disappeared and myocardic perfusion electrocardiographic patterns were corrected. Because of the unfavorable natural course of the disease and the improvement in techniques of coronary revascularization in infants we recommend an early surgical treatment as soon as it be diagnosed. We consider that the most adequate surgical treatment is the direct aortic reimplantation of the anomalous coronary artery.     

Anomalous origin of the left coronary artery from the pulmonary artery; Report of a case diagnosed clinically and confirmed by necropsy

A case is presented of anomalous origin of the left coronary artery from the pulmonary artery in which the condition was diagnosed during life. The diagnosis was made on the following observations: paroxysms of cardiac pain characterized by sweating, pallor, cyanosis, and dyspnea; great enlargement of the heart both clinically and by x-ray examination; and electrocardiograms showing inversion of the T waves in Leads I and II. These constitute a syndrome indicating inadequate arterial blood supply to the heart muscle. The clinical diagnosis was confirmed by necropsy which revealed a left coronary artery arising from the pulmonary artery and supplying the left ventricle alone. No anastomotic coronary circulation existed.     

Anomalous origin of the right coronary artery from the pulmonary artery

Two patients with an anomalous right coronary artery arising from the pulmonary artery are presented. The first patient was asymptomatic and had a continuous murmur. The correct diagnosis was established by cardiac catheterization and selective angiography. There was a moderate sized shunt from the dilated left anterior descending coronary artery to the right coronary artery, which arose from the main pulmonary artery. The second patient was also asymptomatic but died several days after a sudden cardiorespiratory arrest. On postmortem examination she was demonstrated to have anomalous origin of the right coronary artery from the pulmonary artery. The left coronary artery was completely occluded at the orifice by a thrombus, and microscopic examination demonstrated evidence of both acute and chronic left ventricular ischemia and infarction. The pathophysiologic alterations and potential danger to patients with this anomaly are discussed.     

Anomalous origin of left coronary artery from pulmonary artery in adults

Various techniques have been described for management of anomalous origin of the left coronary artery from the pulmonary artery presenting in adults. Three patients, 1 male and 2 females, aged 27-37 years, underwent transpulmonary pericardial patch closure with concomitant left internal thoracic artery anastomosis to the left anterior descending artery, under standard cardiopulmonary bypass, thus creating a two-coronary system. One patient had concomitant mitral valve repair. All 3 survived the operation. Postoperative angiography in 2 patients revealed good antegrade flow with decreased collaterals in one and competitive inhibition with increased collaterals in the other. This procedure is considered to be the safest and simplest in this subset of patients.     

Anomalous origin of the left coronary artery from the pulmonary artery in an adult.

Anomalous origin of the left coronary artery from the pulmonary artery is a rare, almost universally fatal form of congenital heart disease. A case was diagnosed in a 19 year old woman who had exercise induced syncope and ST segment displacement during exercise stress testing. The anomaly was successfully treated with ligation of the anomalous left coronary artery combined with saphenous vein grafting. Young adults with exercise induced syncope should be examined by exercise stress testing, and if it induces ST segment displacement coronary angiography should be undertaken.