An unusual presentation of anomalous left coronary artery from the pulmonary artery (ALCAPA) syndrome in a 70-year-old man: a case report

Abstract

BackgroundWe present a rare case of anomalous origin of the left coronary artery from the pulmonary artery syndrome in an elderly man, and we describe coronary computed tomographic angiographic imaging findings to improve diagnostic confidence for the evaluation of this uncommon coronary artery anomaly.Case presentationA 70-year-old Caucasian man came to our hospital with slight limitation of physical activity (New York Heart Association class II). He was asymptomatic for angina, syncope, and palpitations. Cardiac magnetic resonance imaging was performed after echocardiography because a hypertrophic cardiomyopathy was suspected; a plausible coronary artery anomaly was demonstrated as collateral evidence. Subsequently, coronary computed tomographic angiography showed the anomalous origin of left coronary artery from the pulmonary artery; the coronary vessels appeared markedly dilated and tortuous. Dilated intercoronary vessels along the epicardial surface of the heart and dilated bronchial arteries, corresponding to collateral pathways, were observed. Left ventricular hypertrophy, delayed subendocardial enhancement, and mitral insufficiency were better evaluated on magnetic resonance images. Invasive coronary angiography confirmed the main findings. Given the patient’s age and clinical performance, surveillance with medical management was considered appropriate, and surgical repair was avoided.ConclusionsConfidence with the anatomic pattern and clinical significance of this anomalous condition is necessary to improve cardiac imaging evaluation ability. In our patient, coronary computed tomographic angiography proved to be a reliable imaging approach, superior to invasive coronary angiography in terms of diagnostic performance and patient safety.

Diagnóstico por Imagem: Origem Anômala da ACE Saindo do Tronco da Artéria Pulmonar

“…CCTA allows a non-invasive accurate diagnosis, depicting the origin and course of the coronary arteries. Additionally, it offers a three-dimensional assessment of the anatomic relations between coronary arteries and adjacent structures, 6 and it provides sectional views of cardiac structures from various angles. Hence, it could be considered as the imaging modality of choice to noninvasively delineate coronary vessel anatomy.…”

Caso 2/2020 – Origem Anômala da Artéria Coronária Esquerda do Tronco Pulmonar, em Evolução Natural em Adulta Assintomática de 75 Anos

“…Refusal to surgery has also occurred in similar cases reported in the literature. [1][2][3] Comments: This patient's natural evolution until advanced age, with no symptoms and a few adverse manifestations, is undoubtedly a very rare phenomenon. This favorable evolution, under good clinical and hemodynamic conditions, was primarily due to the exuberant collateral circulation from the RC, which managed to ensure adequate coronary circulation as a whole.…”

Origem Anômala da Artéria Coronária Circunflexa da Artéria Pulmonar Direita: Diagnóstico por TC Cardíaca

“…Além disso, desempenha um papel importante no planejamento de intervenção cirúrgica e pode ser uma ferramenta valiosa no acompanhamento pós-operatório para pacientes adultos. 10 Foi demonstrado que a ATAC controlada por ECG foi superior à angiografia em termos de sensibilidade em várias séries. 6 As Diretrizes de 2018 da ACC/AHA para o Manejo de Adultos com Doença Cardíaca Congênita recomendam o uso da ATAC como método de triagem para o diagnóstico e o manejo de pacientes com anomalias coronárias congênitas de origem arterial ectópica.…”