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 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 left coronary artery from pulmonary artery associated with pulmonary hypertension

This is a report on a 10-year-old child with anomalous origin of left coronary artery (LCA) from pulmonary artery (ALCAPA), severe pulmonary hypertension (PH), old myocardial infarction and poor intercoronary collateralization. It discusses the echocardiographic pitfalls in this particular setting and introduces a new echocardiographic view (posterior pulmonary cusp view) for visualization of the anomalous origin of LCA from the posterior pulmonary cusp (PC) in patients with ALCAPA from the PC of the pulmonary artery. We describe three echocardiographic pitfalls that can mislead the echocardiographer and two helpful hints that guide the clinician to the correct diagnosis.The survival of this child shows that limited size of left ventricular myocardial infarction and severe mitral regurgitation in early infancy can result in a life-saving pulmonary hypertension which preserves viability and function of left ventricle despite lack of intercoronary collateral arteries. After one year follow-up, she is doing well on medical treatment.     

Anomalous origin of the left coronary artery from the pulmonary artery in adults

A 24 year old male with anomalous origin of the left coronary artery from the pulmonary artery was surgically treated with aortocoronary bypass with saphenous vein graft. The clinical signs and pathophysiology of this cardiopathy are reviewed, with emphasis on the great importance of collateral circulation in its prognosis.     

Anomalous origin of the left anterior descending coronary artery from the pulmonary artery

Three children were identified as having anomalous origin of the left anterior descending coronary artery (LAD) from the pulmonary artery (PA). Two had had congestive heart failure in infancy with clinical diagnosis of endocardial fibroelastosis and all had abnormal ECGs. The correct diagnosis was delayed in each case, and two patients required selective coronary angiography. Surgery was accomplished in the three children although ECG abnormalities have persisted and one child has dyskinesis of the left ventricular apex. Because this diagnosis may be difficult to make when intercoronary anastomoses are inadequate to outline the left anterior descending coronary flow into the PA, patients with clinical findings suggestive of anomalous coronary artery may require selective coronary studies to exclude this anomaly.     

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.     

Anomalous origin of left coronary artery from the pulmonary artery with ventricular septal defect

Only two cases have been reported previously of the association of ventricular septal defect (VSD) with anomalous origin of the left coronary artery (ALCA) arising from the pulmonary artery. The purpose of this paper is to present two additional cases, to describe the pathophysiology, and to emphasize how the clinical course of this combination of defects differs from that of isolated ALCA. Patients with both of these anomalies present in infancy with manifestations only of a large left-right ventricular shunt and pulmonary hypertension. Initially the ALCA is well perfused from the high pressure in the pulmonary artery. In these instances in which the pulmonary artery pressure subsequently decreased because of spontaneous reduction in size of the VSD, the left coronary arterial system became less well perfused. Because of this decreased perfusion in association with the left ventricular myocardial stress initially caused by volume overload, myocardial ischemia and ultimately infarction occurred. Early identification and repair of the anatomic abnormality could prevent irreversible myocardial damage.     

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.     

Anomalous origin of left coronary artery from the right pulmonary artery with coarctation of aorta

The patient had a rare complex of congenital cardiovascular anomalies, namely anomalous origin of left coronary artery from the right pulmonary artery and coarctation of aorta. At the age of 2, the patient underwent coarctation repair. Before the coronary anomaly was detected in adulthood, she developed anginal attacks. Investigation revealed the anomalous origin of left coronary artery from the right pulmonary artery and recoarctation with aneurysm distal to it. Direct implantation of the anomalous coronary artery into the aorta and reconstruction of the right pulmonary artery with a pericardial patch was performed, followed by repair of the recoarctation.     

Anomalous origin of left coronary artery from pulmonary artery. Treatment by aorto-left coronary saphenous vein bypass

Definitive surgical therapy is available for the adult or post-infantile form of anomalous origin of the left coronary artery from the pulmonary trunk. Left coronary artery ligation has proved successful because of intercoronary anastomoses; however, more desirable treatment consists of establishing a 2-coronary arterial system, if possible by aorto-left coronary bypass. A 34 year old patient is described in whom aorto-left coronary artery continuity was established using an autogenous saphenous vein bypass graft.