Anesthetic and intensive care management of left main coronary artery to main pulmonary artery fistula diagnosed in postoperative case of tetralogy of fallot

Abstract Funding Acknowledgements Not Applicable OnBehalf Not Applicable Introduction Pulmonary blood supply in patients of Tetralogy of Fallot with pulmonary atresia is usually from patent arterial duct or major aortopulmonary collaterals (MAPCAs) arising from descending thoracic aorta. We describe a case in which large coronary to pulmonary artery fistula was the primary source of pulmonary blood supply. Case Report A 17 years old female was referred to our hospital for diagnostic workup of suspected congenital heart disease. She was previously undiagnosed and now complains of progressive shortness of breath for last few months. On physical examination she was non-dysmorphic with oxygen saturation of ∼ 77 % in room air, blood pressure of ∼ 117/72 mmHg, pulse rate of ∼ 89 beats per minute and respiratory rate of ∼ 24 breaths per minute. She was clinically cyanosed with grade 3 clubbing and polycythemic. Cardiovascular examination revealed quiet precordium with normally placed apex beat, grade 2 parasternal heave with single second heart sound and grade 3/6 continuous murmur along left mid sternal border. Twelve lead electrocardiogram (ECG) showed normal sinus rhythm, right axis deviation and right ventricular hypertrophy. There was no evidence of ischemia. Chest X-ray revealed "boat shaped heart" with oligaemic lung fields. Transthoracic echocardiography showed large conoventricular ventricular septal defect with bidirectional flow. There was aortic over-ride with dilated left main coronary artery. No forward flow was seen across right ventricular outflow tract. Considering hugely dilated left main coronary artery, suspicion of coronary to pulmonary artery fistula was made and cardiac computed tomography followed by conventional angiography was done, both confirmed the diagnosis of Tetralogy of Fallot with pulmonary atresia and large coronary artery to main pulmonary artery fistula as a primary pulmonary blood supply. Two small collaterals (MAPCAs) were also identified supplying small part of right and left lungs. Conclusion This case highlights unusual source of pulmonary blood supply in Tetralogy of Fallot with pulmonary atresia. Correct pre-operative diagnosis is essential for appropriate surgical planning and better outcome. Abstract P1727 Figure. TOF-PA with CA to PA Fistula

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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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Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709616684629 ◽

2017 ◽

Vol 5 (1) ◽

pp. 232470961668462 ◽

Cited By ~ 1

Author(s):

Venkat Gangadharan ◽

Kamesh Sivagnanam ◽

Ghulam Murtaza ◽

Michael Ponders ◽

Otto Teixeira ◽

...

Keyword(s):

Coronary Artery ◽

Pulmonary Artery ◽

Left Main Coronary Artery ◽

Main Pulmonary Artery ◽

Shortness Of Breath ◽

Left Heart ◽

Coronary Angiogram ◽

Left Main ◽

Large Area ◽

The Right

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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Left main coronary artery-to-pulmonary artery fistula with severe aneurysmal dilatation

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2003.05.006 ◽

2004 ◽

Vol 77 (3) ◽

pp. 1081-1083 ◽

Cited By ~ 22

Author(s):

Kimberly L Gandy ◽

Abdallah G Rebeiz ◽

Andrew Wang ◽

James J Jaggers

Keyword(s):

Coronary Artery ◽

Pulmonary Artery ◽

Left Main Coronary Artery ◽

Left Main ◽

Aneurysmal Dilatation ◽

Pulmonary Artery Fistula

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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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Left main coronary artery compression by aneurysmal pulmonary artery in a patient with tetralogy of Fallot with absent pulmonary valve

Catheterization and Cardiovascular Interventions ◽

10.1002/(sici)1522-726x(199904)46:4<438::aid-ccd10>3.0.co;2-6 ◽

1999 ◽

Vol 46 (4) ◽

pp. 438-440 ◽

Cited By ~ 5

Author(s):

P.P. Sengupta ◽

Anita Saxena ◽

Meera Rajani

Keyword(s):

Coronary Artery ◽

Pulmonary Artery ◽

Tetralogy Of Fallot ◽

Left Main Coronary Artery ◽

Pulmonary Valve ◽

Absent Pulmonary Valve ◽

Left Main

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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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