Anomalous Left Coronary Artery Arising From Pulmonary Artery

Abstract

Origin of the left coronary artery from the pulmonary artery is an uncommon congenital cardiac anomaly. Brooks (1886) first suggested that blood flow in this condition was from the coronary artery into the pulmonary artery. Nevertheless, the view that blood flow is in the opposite direction, i.e. from the pulmonary artery to the coronary artery, was commonly held until recently. Edwards (1958) and others (Abbott, 1927;Agustsson et al., 1962;Baffes, Ketola, and Tatooles, 1961;Case et al., 1958;Lampe and Verheugt, 1960;Sabiston, Neill, and Taussig, 1960) have recently presented evidence supporting Brooks' suggestion.We are presenting an angiocardiographic and catheter demonstration of flow from an anomalous left coronary artery into the pulmonary artery in a 4-year-old girl. CASE REPORTThe patient, born in this hospital in 1956, by breech delivery after a normal pregnancy, weighed 2740 g. At the time of her birth, her mother was 32 years old and well, and her father was 38. There were three normal siblings and there had been one miscarriage. At birth, she suffered from asphyxia neonatorum and had a weak cry: oxygen and resuscitative measures were required. The patient developed normally but was noted to be a poor feeder from birth. At the age of 4 months, two weeks before her first admission, she began to wheeze and cough and these symptoms persisted to the time of admission.On admission, the heart was found to be enlarged to the left with the apical impulse in the 5th to 6th left intercostal space in the anterior-axillary line. A rough, grade III, systolic murmur was heard over the the entire prmcordium: it was loudest at the apex and was transmitted to the axilla. P2 was louder than A2. Coarse breath sounds and some scattered wheezes were heard bilaterally.Chest X-ray examination demonstrated a very large heart. Areas of pneumonia were present in both lung apices and the left lower lobe was atelectatic (Fig. IA).A cardiogram showed normal sinus rhythm, a mean electrical QRS axis of +300, inverted T waves in leads I, II, aVL, aVF and over the left prwcordium, a prominent R wave in the left prncordial leads, and a deep S in VI. The tracing was consistent with severe left ventricular enlargement.The patient was considered to have congenital heart disease complicated by congestive heart failure and pneumonia. The diagnostic considerations included fibro-elastosis, idiopathic myocarditis, anomalous coronary artery, and glycogen storage disease. There was some immediate improvement with achromycin, penicillin, and digitalis, but after two days of therapy, the infant appeared to be in extremis. Chloramphenicol, ACTH, and cortisone were added to try to reverse the apparent rapid deterioration, and there was great improvement: the steroids were discontinued at the end of a week. A chest radiogram taken just before discharge showed clearing of the lungs but no significant change in the heart size or contour.There were two more admissions during her first year because of failure to thrive and a respiratory infection whi...

A Case Report of an Adolescent with Anomalous Origin of the Left Coronary Artery from the Pulmonary Trunk (ALCAPA)

“…The early clinical course and the subsequent improvement, however, suggests that this cardiac malformation may give rise to a pathophysiologic spectrum, [9][10][11] in our case. In this case, the patient was asymptomatic during the first few weeks of life, but each developed symptoms during infancy.…”

A case of anomalous origin of the left coronary artery from the pulmonary artery presenting with sudden cardiac arrest due to coronary artery steal generated by excessive exercise

“…In the first phase, blood flow is from the pulmonary artery into the anomalous left coronary artery. This forward flow persists in the infant while the pulmonary artery pressure is high [6]. The second phase occurs when the pulmonary artery pressure falls and the blood flow in the left coronary artery becomes retrograde.…”

Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery

“…asymptomatic or nearly so. 4,6,15,16,18 This group has led Edwards'9 to emphasize that the condition is a continuum from inadequate to adequate intercoronary collaterals, and to favor abandonment of the concept of types. We feel that there is indeed a continuum, but that the concept of infantile and postinfantile types is useful both prognostically and therapeutically.…”