Anomalous left main coronary artery detected by CT angiography

The growing improvements of computed tomography have made this technique more and more available for cardiac evaluation. Coronary artery anomalies (CAAs) are often incidental findings in subjects with suspected coronary artery disease (CAD) undergoing coronary angiography or computed tomography coronary angiography (CTCA). In some cases, CAAs can be clinically relevant so their identification could change radically patient management and treatment. We report the case of a 68-year-old male patient with known CAD and associated anomalous origination of the left coronary artery from the opposite sinus.     

小儿左冠状动脉异常的矫治术麻醉管理方法探讨

目的分析小儿起源于肺动脉的左冠状动脉异常矫治手术的麻醉特点,为今后开展类似手术提供可行的麻醉管理方法。方法回顾性分析2006年3月至2010年7月本院20例小儿起源于肺动脉的左冠状动脉异常矫治术的麻醉管理方法。结果采用静吸复合全麻,术中均未出现急性心衰或心梗,CPB时间为58～204（80.6±44.4）min,主动脉阻断时间为25～125（53.4±32.2）min,开放主动脉后均自动复跳,适时应用血管活性药物,以保证麻醉平稳,停CPB时SBP为（78.6±8.0）mmHg,DBP为（45.4±3.5）mmHg,HR为（130.8±10.5）次/min,术中无死亡及麻醉并发症。1例术后第2天死于严重低心排综合征,死亡率为5%,其余痊愈出院。结论小儿左冠状动脉异常矫治术以静吸复合全麻的方法 ,辅以严密监测,尽力维持血流动力学稳定,积极采取各种措施避免加重心肌缺血的麻醉管理方法是正确可行的,可以推广应用于术前有心功能损害的手术。     

Anomalous coronary artery originating from the left anterior descending artery and ending in a blind aneurysm

To the authors'' knowledge this is the first report of an anomalous coronary artery originating from the left anterior descending artery and ending in a blind aneurysm.     

小儿左冠状动脉异常起源于肺动脉的外科矫治

目的 总结小儿左冠状动脉异常起源于肺动脉（ALCAPA）的外科矫治方法及效果。方法 回顾性研究。纳入2015年2月—2020年10月泰达国际心血管病医院9例接受外科手术治疗的小儿ALCAPA患者的临床资料。男2例、女7例,年龄0.2~12.3岁（中位年龄1.7岁）,体质量5.7~44.3 kg（中位体质量11.6 kg）。患者采取个体化手术策略（肺动脉内隧道技术、主动脉壁和带蒂肺动脉壁缝合、带蒂直接移载、左主干开口成形术）恢复双源冠状动脉供血,其中4例同期行二尖瓣成形术。观察指标：监测患儿左心室射血分数（LVEF）和二尖瓣反流程度,并比较其在术前、术后早期、末次随访时的变化。结果 全组患儿均手术顺利,无死亡。2例重症婴儿术后延迟关胸6 d和9 d。9例患儿出院后获随访1个月~4.5年,均未出现心绞痛或心力衰竭症状。患儿术后早期与术前LVEF分别为62.1%（39.0%,63.5%）和59.0%（40.0%,64.5%）,差异无统计学意义（Z=14.00,P=1.000）;末次随访LVEF为64.0%（60.5%,67.5%）,较术后早期改善,差异有统计学意义（Z=26.50,P=0.034）。术后早期二尖瓣反流与术前、末次随访比较,差异均无统计学意义（Z=1.13、1.41,P=0.257、0.157）。结论 对于小儿ALCAPA采用个性化外科矫治手术可以获得满意的近中期效果。     

Anomalous origin of additional coronary artery arising from the pulmonary artery in complex congenital heart disease

Anomalous origin of coronary arteries is a rare congenital defect and usually presents as an isolated defect. In only 5% of cases, it may be associated with other cardiac anomalies. In this article, we present a case of a newborn with a very complex congenital cardiac disease accompanied with an anomalous origin of an additional coronary artery.     

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), a forgotten congenital cause of sudden death in the adult

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a very rare often fatal congenital coronary artery anomaly that occurs in approximately only 1 of 300,000 live births. Many cardiologists and pathologists may be unaware that cardiac ischemia and sudden death can also occur due to ALCAPA in adults in whom it is even rarer and thus may be missed at autopsy. The adult form may range clinically from asymptomatic to sudden cardiac death. We present four cases of adult ALCAPA that illustrate the variable presentations and survival. Two had died at rest and were previously asymptomatic. The other two died during exertion with history of recent chest pains in one and previous myocardial infarction in childhood in the other. This last case remained asymptomatic until death. These four cases highlight that surgery should be undertaken in all cases, even in those who are asymptomatic as newer imaging makes the diagnosis in life more frequent. Age is not important as cases vary widely in age from 22 to 68 in our small group. Furthermore, the most common site of left coronary artery origin is the left pulmonary sinus but our autopsy study shows that the origin can be variable extending above the pulmonary valve sinus to the main pulmonary artery.     

Anomalous origin of the left circumflex coronary artery from the right aortic sinus of valsalva and sudden death

Anomalous origin of the left circumflex coronary artery from the right aortic sinus is generally considered a benign condition. We report a 53-year-old man with clinical and pathologic evidence of myocardial infarction and sudden death in the setting of this anomaly, with no evidence of obstructive coronary atherosclerosis.     

Rare coronary anastomoses between the aorta,pulmonary trunk,left coronary artery,and subclavian artery

We report a rare case of coronary anastomoses in an 83‐year‐old male cadaveric heart. Anomalous vessels arose from the right sinus of the aorta, left main coronary artery, left anterior descending artery, left anterior medial atrial artery, and left subclavian artery. These vessels bifurcated and anastomosed, and finally connected to the pulmonary trunk. The present case is categorized as a multilateral coronary artery fistula in cardiology. Clin. Anat. 25:969–972, 2012. © 2012 Wiley Periodicals, Inc.     

Anomalous branch of the left common carotid artery

A previously unreported anomalous branch of the left common carotid artery (LCCA) was observed during dissection at the Zagreb Medical School. The anomalous branch arose from the anterior surface of the LCCA approximately 2 cm superior to the aortic arch, and subsequently bifurcated into a right and left branch. We describe its anatomic features. Clinical implications are also discussed.     

Atresia of left coronary ostium and left main coronary artery

An uncommon coronary anomaly incidentally found at autopsy of a 76-year-old woman is reported. There was no history of cardiovascular symptoms or clinical signs of ischemic heart disease. The autopsy disclosed that the patient had no left coronary ostium and that the left main coronary artery was atretic. However, the rest of the left coronary system, including the left anterior descending coronary artery and the left circumflex coronary artery, were intact in their normal positions. Arterial flow to the left coronary system was supplied by a dilated collateral vessel that originated from the right main coronary artery and coursed between the right ventricular infundibulum and the aorta. Our case suggests that atresia of the left coronary ostium and the left main coronary artery, often associated with death at an early age, may also be compatible with symptom-free longevity. Moreover, attention is focused on the nomenclature of single coronary anomalies.     

Single coronary artery arising anomalously from the pulmonary trunk

A case of sudden death in a 10-day-old infant was studied. Pathologic findings included myocardial infarction and a single coronary artery that arose anomalously from the pulmonary artery. This was the only source of the coronary arterial blood supply.