Anomalous origin of the left coronary artery from the pulmonary artery in a patient of advanced age: a case report and analysis

A 61-year-old Chinese man presented with a nearly 30-year history of an anomalous origin of the left coronary artery. He had been diagnosed with an anomalous origin of the left coronary artery in 1989. He then underwent regular echocardiographic examinations and it was found that his heart was gradually enlarging. After a >20-year asymptomatic period, he developed recurrent chest discomfort and palpitation. Coronary computed tomography angiography suggested that the left coronary artery anomaly originated from the pulmonary artery; additionally, the right coronary artery was tortuous and thickened. Coronary angiography showed that the right coronary artery was huge and buckling. The patient underwent corrective surgery of the anomalous origin of the left coronary artery from the pulmonary artery, aortic valve mechanical valve replacement, mitral valve plasty, and tricuspid valve plasty in Fuwai Hospital (National Center of Cardiovascular Disease of China), and the anatomic results of the surgery were good.

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Anomalous Origin of the Left Coronary Artery: The Physiologic Defect and Suggested Surgical Treatment

PEDIATRICS ◽

10.1542/peds.22.5.909 ◽

1958 ◽

Vol 22 (5) ◽

pp. 909-909

Keyword(s):

Coronary Artery ◽

Surgical Treatment ◽

Pulmonary Artery ◽

Right Coronary Artery ◽

Left Coronary Artery ◽

Anomalous Origin ◽

Single Coronary Artery ◽

Artery Ligation ◽

Perfusion Studies ◽

The Right

The majority of infants born with an anomalous origin of the left coronary artery from the pulmonary artery die within the first year of life. This malformation produces a clinical picture of episodes of sweating, cyanosis and pallor usually following feeding. Associated findings are gross cardiac enlargement and electrocardiographic evidence of myocardial ischemia. Perfusion studies at necropsy indicate that extensive anastomoses allow free passage of blood from the normal right coronary artery to the left. There now appears evidence that flow through the anomalous left coronary artery is into the pulmonary artery rather than away from it. Thus although there is oxygenated blood in the left coronary artery, it does not reach the myocardium but passes instead to the low-resistance circuit of the pulmonary artery. Ligation of the aberrant vessel at its origin would prevent retrograde flow and allow perfusion of the left ventricle by blood supplied through the anastomoses from the right coronary artery. This would in effect convert the anomaly into that of a single coronary artery arising from the aorta, which situation is usually compatible with a normal life expectancy. Preliminary experience with this suggested surgical treatment appears encouraging in one of the cases reported.

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Anomalous origin of the right coronary artery from the pulmonary artery: An autopsied sudden death case with severe atherosclerotic disease of the left coronary artery

Legal Medicine ◽

10.1016/j.legalmed.2013.11.007 ◽

2014 ◽

Vol 16 (2) ◽

pp. 84-88 ◽

Cited By ~ 2

Author(s):

T. Nagai ◽

T. Mukai ◽

S. Takahashi ◽

A. Takada ◽

K. Saito ◽

...

Keyword(s):

Coronary Artery ◽

Sudden Death ◽

Pulmonary Artery ◽

Right Coronary Artery ◽

Left Coronary Artery ◽

Atherosclerotic Disease ◽

Anomalous Origin ◽

Death Case ◽

The Right

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Anomalous origin of the left coronary artery from the right pulmonary artery complicating a case of coarctation of the aorta

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2004.03.014 ◽

2004 ◽

Vol 18 (3) ◽

pp. 327-331 ◽

Cited By ~ 2

Author(s):

Ijas Moideen ◽

Suresh G Nair ◽

Abraham Cherian

Keyword(s):

Coronary Artery ◽

Pulmonary Artery ◽

Left Coronary Artery ◽

Coarctation Of The Aorta ◽

Anomalous Origin ◽

Right Pulmonary Artery ◽

The Right

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Intramural Aortic Course Should Always Be Considered for Anomalous Origin of the Left Coronary Artery From the Right Pulmonary Artery

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135118799645 ◽

2019 ◽

Vol 10 (4) ◽

pp. 508-512

Author(s):

Vishal Agrawal ◽

Nikunj Vaidhya ◽

Mrinal Patel ◽

Amit Mishra ◽

Dinesh Patel

Keyword(s):

Coronary Artery ◽

Pulmonary Artery ◽

Left Coronary Artery ◽

Anomalous Origin ◽

Preoperative Imaging ◽

Rare Entity ◽

Right Pulmonary Artery ◽

The Right

Anomalous origin of the left coronary artery (LCA) from the right pulmonary artery (ALCARPA) is an extremely rare subset of an already rare entity, anomalous origin of the LCA from the pulmonary artery. Whenever it is diagnosed preoperatively, one should be extremely vigilant about the potential intramural course of the descending part of the LCA in the aorta. Preoperative imaging frequently fails to delineate this intramural course. We report our experience with one such case where we had accidentally injured the LCA during dissection from the right pulmonary artery. Although it was successfully managed, it reinforces our aforementioned point concerning the importance of vigilance in seeking to identify intramurality as a component of this anomaly of coronary artery origin.

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A right coronary artery aneurysm 16 years after surgical repair of anomalous origin of the right coronary artery from the pulmonary artery

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivy356 ◽

2019 ◽

Vol 29 (1) ◽

pp. 157-158

Author(s):

Akira Furutachi ◽

Kojiro Furukawa ◽

Aiko Komatsu ◽

Eijiro Nogami

Keyword(s):

Coronary Artery ◽

Pulmonary Artery ◽

Right Coronary Artery ◽

Surgical Repair ◽

Artery Aneurysm ◽

Anomalous Origin ◽

Artery Graft ◽

Long Term Follow Up ◽

The Right

Abstract Anomalous origin of the right coronary artery (RCA) from the pulmonary artery is a very rare congenital heart disease, and several reports have described long-term events after surgery. We report the case of a 46-year-old woman who underwent reimplantation of the RCA for anomalous origin of the right coronary artery from the pulmonary artery 16 years ago. An RCA aneurysm gradually developed and dilated over time, and we resected the aneurysm and also grafted the right gastroepiploic artery graft to the distal RCA. Careful long-term follow-up is required to avoid overlooking such a rare but life-threatening complication after surgical repair of anomalous origin of the right coronary artery from the pulmonary artery.

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