A Later Stage of Anomalous Coronary Circulation with Origin of the Left Coronary Artery from the Pulmonary Artery

Abstract

A 45-year-old woman with angina pectoris, beginning at the age of 16 and progressing to produce incapacitation, was found to have an anomalous left coronary artery arising from the pulmonary artery. Because of the severity of symptoms and progression of disability, the anomalous artery was ligated at its origin from the pulmonary artery. Pressure in the left coronary system increased from 35/10 to 105/30 mm Hg. Since operation the patient has been relieved of her symptoms. There was no evidence of increased myocardial ischemia after ligation. This indicates that operative treatment of this anomaly can be carried out successfully in the older age group. It is also suggested that a fourth stage of progression of this anomaly occurs in which there is an exaggeration of the intercoronary communications between the right and left coronary systems. This produces such a large arteriovenous shunt that blood flow to the myocardium is again reduced, resulting in a "coronary steal syndrome."

Outcomes from anomalous origin of the left coronary artery from the pulmonary artery repair: Long-term complications in relation to residual myocardial abnormalities

“…Several authors have reported that despite the improvement in or even the normalization of left ventricular function after surgical intervention, limitations associated with the myocardial blood flow or chronic myocardial injury can persist for years after surgery [12,14,15]. Left to right shunting from the RCA via the LCA to the PA, which is known as the coronary steal phenomenon, creates collateral vessels and coronary aneurysms or stenoses in patients with adult-type ALCAPA [16,17]. The anterograde LCA flow is hindered or occluded after dual-coronary system surgery.…”

Anomalous origin of the left anterior descending coronary artery from the pulmonary artery: Surgical correction in an adult

“…However, as collaterals become larger and more efficient, they offer less resistance to flow and promote true "steal" from the area of supply of the normally arising coronary arteries. This has been proposed by Baue et a1 [7] and explains the delayed onset of symptoms in patients reaching the adult age. It is supported by the absence of the venous phase in our preoperative coronary arteriograms.…”

Síndrome de ALCAPA en adulto: Caso clínico

“…La forma adulta solo es posible en aquellos casos en que hay un gran desarrollo de colaterales desde el sistema coronario derecho hacia el izquierdo, estableciéndose un flujo retrógrado desde la ACI hacia la AP 9 . No obstante, el número y calibre excesivo de colaterales producen un abundante cortocircuito arteriovenoso desde la ACD hacia la AP, dando origen a un síndrome de robo coronario, pudiendo así producir sintomatología en el adulto 10 . En una revisión por Yau et al de 151 casos adultos, se describe la presentación clínica y los hallazgos de laboratorio en estos pacientes 3 .…”