Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery

A 36-year-old woman was seen with complaints of exertional chest pain and shortness of breath. Her medical history included atrial fibrillation and diabetes. Physical examination was unremarkable except for an irregular cardiac rhythm. Myocardial perfusion imaging revealed the presence of a large area of infarction involving the entire anterior and apical walls and part of the anteroseptal wall with minimal periinfarct ischemia. Computed tomography coronary angiogram revealed an anomalous left main coronary artery arising from the main pulmonary artery. Right and left heart catheterizations demonstrated moderate pulmonary hypertension with a slight step-up in oxygen saturation between the right ventricle and main pulmonary artery. Coronary angiography showed a large tortuous right coronary artery with collaterals to the left anterior descending artery that drained into the main pulmonary artery. She was referred for surgery. This case demonstrates a rare coronary artery anomaly in an adult where survival is dependent on collateral circulation.

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ANOMALOUS AORTIC ORIGIN OF THE LEFT MAIN CORONARY ARTERY ASSOCIATED WITH ARTERIAL COMPRESSION - CASE REPORT

10.22541/au.160927527.79031349/v1 ◽

2020 ◽

Author(s):

Davi Tenório ◽

Leonardo Miana ◽

Antonio Carlos de Almeida Barbosa Filho ◽

Monica Gonzales Coronel ◽

Gustavo Guerreiro ◽

...

Keyword(s):

Coronary Artery ◽

Pulmonary Artery ◽

Left Coronary Artery ◽

Left Main Coronary Artery ◽

Postoperative Recovery ◽

Shortness Of Breath ◽

Left Main ◽

External Compression ◽

The Right

Anomalous Aortic Origin of Coronary Artery (AAOCA) is a rare finding, with varied presentation and symptomatology. Increasingly recognized by cardiac imaging, when found it raises questions about the appropriate approach and management. We present a case of an 11-year-old female who presented with episodes of shortness of breath, angina and syncope during exercise. Further investigation demonstrated episodes of nonsustained ventricular tachycardia on Holter and coronary angiotomography revealed that the left coronary artery had an anomalous origin from the right cusp with initial short intramural segment and significant external compression in its initial course between the aorta and the pulmonary artery. Patient was submitted to surgical correction with dissection of left coronary artery posterior to the pulmonary artery, coronary arteriotomy, roof ampliation with autologous pericardium and creation of neo-ostium in aorta. Patient had satisfactory postoperative recovery, was discharged on the fifth day post op, and remains asymptomatic after six months follow-up. Herein we present surgical video and postoperative echo and CT scan.

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Ligation of a Fistula between the Left Main Coronary Artery and Both the Pulmonary Artery and the Right Ventricle

The Heart Surgery Forum ◽

10.1532/hsf98.20111083 ◽

2012 ◽

Vol 15 (2) ◽

pp. 119 ◽

Cited By ~ 2

Author(s):

I. Halil Algin ◽

Aytekin Yesilay ◽

N. Murat Akcar

Keyword(s):

Cardiopulmonary Bypass ◽

Coronary Artery ◽

Pulmonary Artery ◽

Right Ventricle ◽

Left Main Coronary Artery ◽

Coronary Artery Fistula ◽

Left Main ◽

Symptomatic Disease ◽

Coronary Artery Fistulas ◽

The Right

The frequency of coronary artery fistula among all coronary angiography patients is 0.1% to 0.2%; however, involvement of both the pulmonary artery and the right ventricle is a rare clinical entity. A 53-year-old man patient was admitted to our clinic with rarely occurring chest pain, palpitations, and dyspnea. A coronary angiogram showed a fistula between the left main coronary artery and both the pulmonary artery and the right ventricle. We performed a ligation of this fistula without cardiopulmonary bypass. Aorta and right ventricle sutures were made, and the proximal and distal portions of the fistula were obliterated with 5-0 Prolene sutures and previously prepared Teflon felt. The patient recovered and was discharged without any complications. The surgical indications for coronary artery fistulas are symptomatic disease, an aneurysmic coronary artery, signs of heart failure, and ischemia. The surgical options in such cases�depending on whether the fistula is complicated or not�are simple ligation or transarterial ligation under cardiopulmonary bypass.

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Left main coronary artery compression by the dilated main pulmonary artery in adult atrial septal defect. Three cases report.

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.20.1211 ◽

1991 ◽

Vol 20 (6) ◽

pp. 1211-1213

Author(s):

K. Fujiwara

Keyword(s):

Coronary Artery ◽

Pulmonary Artery ◽

Atrial Septal Defect ◽

Septal Defect ◽

Left Main Coronary Artery ◽

Main Pulmonary Artery ◽

Left Main

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Successful sparing approach between the ascending aorta and the main pulmonary artery to the giant coronary aneurysm of the left main coronary artery

BMJ Case Reports ◽

10.1136/bcr-2019-234203 ◽

2020 ◽

Vol 13 (4) ◽

pp. e234203

Author(s):

Ken Nakamura ◽

Kouan Orii ◽

Takayuki Abe ◽

Hirofumi Haida

Keyword(s):

Coronary Artery ◽

Pulmonary Artery ◽

Left Main Coronary Artery ◽

Main Pulmonary Artery ◽

Coronary Aneurysm ◽

Ascending Aorta ◽

Left Main ◽

Giant Coronary Aneurysm

Coronary aneurysm located just above the left main coronary artery (LMT) is rare and difficult to treat. How the aneurysm is accessed is very important as it determines the result of the surgery. A 70-year-old man with a large coronary aneurysm (40 mm in diameter) in the LMT underwent surgery to prevent its rupture; however, there was severe adhesion. Initially, dissection of the ascending aorta or the pulmonary artery seemed necessary to access the aneurysm; however, the process was possible with limited dissection between the ascending aorta and the pulmonary artery, and we succeeded in firmly closing the LMT site of entry.

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Left main coronary artery compression by a dilated main pulmonary artery and left coronary sinus of Valsalva aneurysm in a patient with heritable pulmonary arterial hypertension and FLNA mutation

Pulmonary Circulation ◽

10.1177/2045893217716107 ◽

2017 ◽

Vol 7 (3) ◽

pp. 734-740 ◽

Cited By ~ 2

Author(s):

Akihiro Hirashiki ◽

Shiro Adachi ◽

Yoshihisa Nakano ◽

Yoshihiro Kamimura ◽

Takeshi Ogo ◽

...

Keyword(s):

Coronary Artery ◽

Pulmonary Arterial Hypertension ◽

Pulmonary Artery ◽

Coronary Sinus ◽

Left Main Coronary Artery ◽

Main Pulmonary Artery ◽

Sinus Of Valsalva ◽

Left Main ◽

External Compression ◽

Pulmonary Arterial

Left main coronary artery (LMCA) disease due to external compression by a dilated main pulmonary artery (MPA) is an uncommon clinical entity. Here, we describe a 52-year-old woman with pulmonary arterial hypertension (PAH) and anteroseptal old myocardial infarction (OMI). The cause of the OMI was external compression of the LMCA by the dilated MPA and aneurysm of the left coronary sinus of Valsalva. The patient’s sister (aged 56 years) had also been diagnosed with PAH and both women had a novel heterozygous splicing mutation, IVS2-2A > G (c.374-2A > G in NM_001456), in the filamin A ( FLNA) gene. To our knowledge, this is the first report of HPAH which is likely to be due to FLNA mutation and compression of the LMCA between a dilated MPA and aneurysm of the left coronary sinus of Valsalva.

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Incidentally Diagnosed Malignant Coronary Artery Anomaly: A Clinical Case

Medicina ◽

10.3390/medicina49100072 ◽

2013 ◽

Vol 49 (10) ◽

pp. 72

Author(s):

Domas Golubickas ◽

Justina Motiejūnaitė ◽

Antanas Jankauskas ◽

Rimvydas Šlapikas ◽

Algidas Basevičius

Keyword(s):

Coronary Artery ◽

Pulmonary Artery ◽

Left Main Coronary Artery ◽

Coronary Artery Anomalies ◽

Heavy Exercise ◽

Left Main ◽

Investigation Methods ◽

The Right ◽

Congenital Coronary Artery Anomalies ◽

Myocardial Hypoperfusion

The incidence of congenital coronary artery anomalies is estimated to range between 1% and 2% in the general population. The separate types of coronary artery anomalies are even rarer – the left main coronary artery arising from the right coronary sinus and passing between the thoracic aorta and the pulmonary artery is one of them. In this case, the segment of the artery that courses between the aorta and the pulmonary artery is prone to compression, especially during heavy exercise. Outcomes may be fatal due to myocardial hypoperfusion, which is associated with sudden cardiac death especially among children, young adults, and athletes. Nowadays, innate coronary artery anomalies may be incidentally diagnosed in older age using new investigation methods such as computed tomography angiography.

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A case of anomalous origin of left main coronary artery from the pulmonary artery combined with anomalous aortic origin of the right coronary artery from the left coronary sinus

Coronary Artery Disease ◽

10.1097/mca.0000000000000832 ◽

2020 ◽

Vol 31 (4) ◽

pp. 400-402

Author(s):

Haiyong Wang ◽

Litao Ruan

Keyword(s):

Coronary Artery ◽

Pulmonary Artery ◽

Right Coronary Artery ◽

Coronary Sinus ◽

Left Main Coronary Artery ◽

Anomalous Origin ◽

Left Main ◽

The Right

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Abstract 16067: Unique Challenge of Acs - Anomalous Left Main Coronary Artery From Right Coronary Cusp

Circulation ◽

10.1161/circ.142.suppl_3.16067 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Srinivas Nadadur ◽

Justice Oranefo ◽

Muhammad Adeel ◽

Mansour Khaddr ◽

Wassim Mosleh

Keyword(s):

Coronary Artery ◽

Coronary Angiography ◽

Troponin I ◽

Left Main Coronary Artery ◽

Coronary Angiogram ◽

Left Main ◽

Unique Challenge ◽

Coronary Cusp ◽

The Right ◽

Right Coronary Cusp

Introduction: Anomalous aortic origin of coronary arteries (AAOCA) is uncommon congenital anomalies of the coronary circulation. Anomalous left main coronary artery (LMCA) originating from the right cusp is one of the rarer anomalies (incidence ~ 0.03% of patients undergoing coronary angiography). Mostly asymptomatic, however, this may become clinically significant with symptoms ranging from atypical chest discomfort to sudden cardiac death. We present a case of anomalous origin LMCA from the right coronary cusp. Case presentation: A 47-year-old female presented to the ED with three days of substernal chest pressure at rest. BP 106/71 mmHg, pulse 72 bpm, normal regular heart sounds, and clear lungs. The ECG showed new anterolateral T-wave inversions. Troponin-I was 0.31 ng/ mL. Echocardiogram showed normal LVEF without focal wall motion abnormalities. Coronary angiography revealed a dominant patent RCA without any disease. LMCA originated from the right coronary cusp with focal 90% ostial LAD stenosis. The rest of the coronary tree was free of disease. CABG with LIMA to LAD and SVG to OM1 was performed. Discussion: AAOCA presents a unique challenge to diagnosis and management. CT coronary angiogram or magnetic resonance angiography is recommended for more accurate delineation of the course of the coronary vessel. The diagnostic challenge to effectively engage the anomalous artery and to obtain coronary angiogram to delineate anatomy is critical in further management. As seen in our case, this is easy to overlook and in the acute event could lead to unnecessary delay.

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Coronary artery–pulmonary artery fistula in pulmonary atresia with ventricular septal defect: report of two surgical cases

Cardiology in the Young ◽

10.1017/s1047951121003796 ◽

2021 ◽

pp. 1-4

Author(s):

Arif Yasin Çakmak ◽

Ilker Kemal Yucel ◽

Ahmet Sasmazel

Keyword(s):

Coronary Artery ◽

Pulmonary Artery ◽

Septal Defect ◽

Left Main Coronary Artery ◽

Ductus Arteriosus ◽

Pulmonary Atresia ◽

Left Main ◽

Aortopulmonary Collateral ◽

The Right ◽

Pulmonary Artery Fistula

Abstract Pulmonary atresia with ventricular septal defect is a complex congenital cardiac anomaly. The blood is supplied to the lungs through a patent ductus arteriosus, a major aortopulmonary collateral artery, or in very rare cases from a coronary artery–pulmonary artery fistula. We present two cases with coronary artery–pulmonary artery fistula which underwent surgical intervention. In our first patient, the main pulmonary artery was supplied from the left main coronary artery. In the second patient, the right pulmonary artery originated from the left main coronary artery and continued to the right lung posteriorly to the aorta, while the left pulmonary artery originated from the patent ductus arteriosus. The difference in our cases is that the coronary artery pulmonary artery fistulas behave like major aortopulmonary collateral arteries originating from the coronary arteries. These fistulas were the main source of pulmonary blood flow.

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