An Uncommon Echocardiographic Marker for Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery: Visualization of Intercoronary Collaterals Within the Ventricular Septum

Abstract

A rare and striking echocardiographic finding with color-flow Doppler--visualization of intercoronary collaterals within the ventricular septum--in an asymptomatic 5-year-old girl is reported. It strongly suggests anomalous origin of the left coronary artery from the pulmonary artery. Several additional echocardiographic features can secure the diagnosis and allow one to proceed with surgical correction without confirmatory cardiac catheterization and angiocardiography. The ages of our patient and of the seven cases reported previously suggest that these collaterals will more likely be identified beyond infancy and in relatively asymptomatic patients with this congenital anomaly.

Anomalous left coronary artery from pulmonary artery: Case series and brief review

“…ALCAPA patients surviving beyond one year without treatment, coronary collaterals have been found to be obvious septal color flow signals echocardiographically. The identification of these septal collaterals is the initial clue for the diagnosis of ALCAPA in patients over one year of age [13,14]. In our study group, 80% of the patients were strongly suspected as ALCAPA echocardiographically and the most common findings were mild to moderate mitral valve regurgitation, echogenic left ventricular papillary muscles, some degree of left ventricle dilatation/dysfunction and prominent right coronary artery with collaterals like flow in interventricular septum and then to pulmonary artery.…”

Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery: Diagnoses and Surgical Results in 12 Pediatric Patients

“…This phenomenon should not be confused with multiple ventricular septal defects. 17 Mitral regurgitation caused by ischemia of the papillary muscles is so characteristic that its absence, even …”

Comprehensive intraoperative transesophageal echocardiography of anomalous left coronary artery from pulmonary artery: What to look for and where to look?

“…Collaterals in adult variety are not only restricted to the septum as in the infantile variety but might develop on the inferolateral surface between the posterior descending artery and the left circumflex coronary artery and anterior surface between the LCA and RCA (Figure C) . A bigger septal collateral may sometimes be confusing with a smaller ventricular septal defect which may need to be differentiated by the Doppler, color pattern, and 3DTEE . Indirect evidence of the collateralization can be obtained from the RCA: aortic root ratio.…”

“…4 Figure 2C). 5 A bigger septal collateral may sometimes be confusing with a smaller ventricular septal defect 6 which may need to be differentiated by the Doppler, color pattern, and 3DTEE. 6 Indirect evidence of the collateralization can be obtained from the RCA: aortic root ratio.…”