Correction of anomalous origin of left coronary artery using left subclavian artery.

A case of anomalous origin of the left coronary artery from the pulmonary artery is reported in which surgical correction by anastomosis of the left subclavian artery to the left coronary artery was performed at the age of 6 months. There was a dramatic clinical improvement, and at 22 months repeat angiocardiography disclosed a patent graft and remarkable improvement in left ventricular function. It is recommended that this is the operation of choice for infants in whom cardiac catheterisation fails to show a shunt into the pulmonary artery or the shunt is small.     

An operation for anomalous origin of left coronary artery.

Successful surgical correction for anomalous origin of the left coronary artery from the pulmonary artery in a 4-year-old child is reported. An aortopulmonary fistula was created and a pericardial baffle was inserted within the pulmonary artery to connect the fistula to the ostium of the left coronary artery. The clinical, haemodynamic, and angiographic features of the anomaly are presented. The child's progress is satisfactory 17 months after the operation.     

Klinefelter's syndrome with anomalous origin of left main coronary artery

Klinefelter's syndrome is a rare entity. Even rarer is an anomalous origin of the Left Main Coronary Artery. For both conditions to occur in the same patient is hence exceedingly rare. Reported here is a never previously reported case of a coronary congenital anomaly in a patient with Klinefelter's syndrome together with the proper angiographic approach.     

Repair of anomalous origin of left coronary artery from the pulmonary artery

Patients with anomalous origin of the left coronary artery from the pulmonary artery often have mitral valve regurgitation. Although establishing dual coronary circulation is the procedure of choice, there remains controversy as to how the mitral valve is handled. Between April 1999 and August 2005, 8 patients underwent surgical correction at our institution. There were 4 males and 4 females, aged from 9 months to 13 years (mean, 6.4 years). Six patients underwent direct aortic reimplantation and 2 had a Takeuchi procedure. Simultaneous mitral annuloplasty was performed in 7 patients with moderate or severe mitral regurgitation. There were no deaths or postoperative complications. Follow-up ranged from 4 to 80 months (mean, 34 +/- 26 months). Left ventricular function improved significantly from a preoperative fractional shortening of 0.21 +/- 0.09 to 0.35 +/- 0.06. Mitral regurgitation decreased on follow-up in the 7 patients who had mitral annuloplasty. We recommend performing mitral annuloplasty at the time of operation in patients with moderate or severe mitral regurgitation and anomalous origin of the left coronary artery from the pulmonary artery.     

An operation for anomalous origin of left coronary artery.

Successful surgical correction for anomalous origin of the left coronary artery from the pulmonary artery in a 4-year-old child is reported. An aortopulmonary fistula was created and a pericardial baffle was inserted within the pulmonary artery to connect the fistula to the ostium of the left coronary artery. The clinical, haemodynamic, and angiographic features of the anomaly are presented. The child's progress is satisfactory 17 months after the operation.     

Imaging the elusive anomalous origin of left coronary artery from pulmonary artery

A 7‐year‐old girl with severe mitral regurgitation and pulmonary artery hypertension with good ventricular function was planned for mitral valve repair, but was subsequently diagnosed to have anomalous left coronary artery from pulmonary artery. We describe the pitfalls in the diagnosis of this rare anomaly, particularly in the presence of severe pulmonary artery hypertension and absence of circumstantial evidence of coronary steal and ventricular dysfunction.     

Multivessel coronary angioplasty with anomalous origin of the left main coronary artery

We report a case of coronary angioplasty to the right coronary artery, the circumflex, and the left anterior descending artery in a patient with anomalous left main coronary artery arising from the right aortic sinus of Valsalva. At angiographically documented follow-up of more than 2 years, the patient remains well without restenosis. This case represents the only such report in the literature. Angioplasty hardware was an important factor in successful crossing and dilatation of multiple severe and distal stenoses in the anomalous left system; appropriate technical details are discussed.     

Single coronary artery, anomalous origin of the right coronary artery from the left anterior descending artery

We present a patient with an abnormal origin of the right coronaryartery from the left anterior descending artery. The patienthad chest pain probably related to myocardial ischaemia. Thisanomaly is very rare and has previously been reported in onlythree cases. The abnormal vessel travelled rightwards and remainedanterior to the main pulmonary artery, it was free of significantstenosis. The mechanism of anterior myocardial ischaemia remainsunexplained.     

Single coronary artery, anomalous origin of the right coronary artery from the left anterior descending artery

We present a patient with an abnormal origin of the right coronaryartery from the left anterior descending artery. The patienthad chest pain probably related to myocardial ischaemia. Thisanomaly is very rare and has previously been reported in onlythree cases. The abnormal vessel travelled rightwards and remainedanterior to the main pulmonary artery, it was free of significantstenosis. The mechanism of anterior myocardial ischaemia remainsunexplained.     

Ultrasonic features of anomalous origin of the left coronary artery from the pulmonary artery

Two cases of anomalous origin of the left coronary artery from the pulmonary artery with and without marked dilatation of the right coronary artery were studied by M-mode echocardiography and cross-sectional echocardiography. The M-mode echocardiogram obtained from the case with the dilated right coronary artery demonstrated an abnormal structure anterior to the aortic root. The cross-sectional echocardiogram of the same case visualized the origin of the dilated right coronary artery. In addition, echocardiographic abnormalities suggesting the ischemia of the left ventricle were observed in both cases. Although many of the ultrasonic features are nonspecific, the combination of ultrasonic technique provides useful clues to the diagnosis of anomalous origin of the left coronary artery from the pulmonary artery.     

Ejection fraction in anomalous origin of the left coronary artery from the pulmonary artery

The ejection fraction of 10 patients with anomalous origin of the left coronary artery from the pulmonary artery has been studied. Five were seen at Albany Medical Center Hospital and 5 were collected from the literature. The 6 patients who died had an ejection fraction less than 0.36. The 4 survivors had an ejection fraction more than 0.55. It has been suggested that this measurement will help in the selection of patients for surgery and the follow-up of patients with this anomaly.     

Echocardiographic diagnosis of anomalous origin of the left coronary artery from the pulmonary artery

The objective of this study was to analyze echocardiographic characteristics of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) and to explore the diagnostic value of transthoracic echocardiography. The echocardiographic characteristics of 8 patients hospitalized with ALCAPA from 2000 to 2005 were analyzed retrospectively, including the results of real time three-dimensional echocardiography in one case, and compared with angiographic results. Eight cases included 6 older type patients and 2 infant type patients. Echocardiography showed abnormal vessel inserting into pulmonary artery (PA), continuous shunt into PA and intercoronary collateral signals within the ventricular septum in all cases and bifurcate structure of the abnormal vessel with retrograde filling in 4 cases. The morphological and functional changes and valvular regurgitation induced by insufficient myocardial perfusion were also evaluated. In former 4 patients, 2 cases were misdiagnosed as right coronary artery-PA fistula and the other 2 cases were given an uncertain diagnosis of anomalous origin of the coronary artery because of the visualization of the echo-free linear structure which apparently arose from the aorta resembling a normal left coronary artery. The latter 4 patients were correctly diagnosed by excluding the aforementioned interference. The diagnosis of ALCAPA was confirmed by angiocardiography in all patients and by intraoperative findings in 4 patients. Based on the apprehension of ultrasonic features and the enhancement of diagnostic alertness, the echocardiography can evaluate ALCAPA accurately and give more information than angiography. It may be the first diagnostic choice.     

Percutaneous coil closure of recanalised anomalous origin of left coronary artery from pulmonary artery

An asymptomatic boy underwent surgical correction of anomalous origin of left coronary artery from pulmonary artery (ALCAPA) with trans-pulmonary artery interruption and saphenous vein grafting to left anterior descending coronary artery. He developed a shunt through the re-canalised pulmonary artery end of the ALCAPA which was successfully embolised using a detachable PDA coil delivered into the left main coronary artery from the pulmonary artery.     

Cross-sectional echocardiographic findings of anomalous origin of left coronary artery from pulmonary artery.

Anomalous origin of the left coronary artery and left ventricular myocardial hypokinesis were visualised by cross-sectional echocardiography. Significant dilatation of the right coronary artery was another important finding. Cross-sectional echocardiography appears to be useful for evaluating patients with anomalous origin of the left coronary artery from the pulmonary artery.