Anomalous Origin of All Coronary Arteries from the Pulmonary Trunk

Abstract

The origin of both coronary arteries from the pulmonary artery is a rare cardiac malformation. We report a baby who presented with an echocardiographically diagnosed perimembranous ventricular septal defect and normal left ventricular (LV) function. Later on the boy developed failure to thrive and increasing tachypnea. At the age of 5 weeks the ECG showed that LV strain and echocardiographic LV function had worsened (FS 18%). Echocardiography and heart catheterization showed that all coronary arteries originated from the pulmonary trunk. Intraoperative inspection revealed a single ostium for the right and left coronary artery in the nonfacing sinus of the pulmonary trunk. A tube was constructed connecting the coronary artery to the ascending aorta. Coronary perfusion was sufficient and the sinus rhythm was restored. However, in the early postoperative period there was a sudden deterioration of cardiac output followed by cardiac arrest. Reanimation was not successful.

Cardiac Arrest During Exercise: Anomalous Left Coronary Artery from the Pulmonary Trunk

“…Although the involvement of LCA is common, an anomalous origin of the circumflex or the RCA from a pulmonary artery has also been reported (4,5) and in an unusual case all coronary arteries originated from the pulmonary trunk (6). With an LCA from the pulmonary trunk, collateral flow from the RCA is often sufficient to prevent angina and serious deterioration of the function of the left ventricle.…”

Separate Origins of All Three Major Coronary Arteries from the Right Sinus of Valsalva:A Rare Coronary Artery Anoma ly

“…The more common anomalies usually demonstrate the origin of one or more coronary arteries from the pulmonary artery [3], the origin of right or left coronary artery from the contralateral sinus of Valsalva [4,5], the origin of the right or left coronary artery from the noncoronary sinus of Valsalva [6], a single coronary artery originating from the left or right sinus of Valsalva [7], a circumflex artery originating from a separate ostium in the left sinus of Valsalva, a circumflex artery originating from the proximal segment of the right coronary artery, and high take-off of the right or left coronary artery from the ascending aorta [8]. All three major coronary arteries arising from three separate ostia in the right sinus of Valsalva are distinctly rare.…”

The anatomy and development of normal and abnormal coronary arteries

“…If suspected and diagnosed, nonetheless, this lesion is now amenable to timely surgical repair. 13 Anomalous origin of one or the other coronary artery from the pulmonary trunk can also be found when the heart itself is congenitally malformed. It cannot be coincidence that the association is frequent in the setting of an aortopulmonary window (Fig 8).…”

“…The much rarer variant of anomalous origin of both coronary arteries from the pulmonary trunk, as might be anticipated, produces much more severe symptoms. If suspected and diagnosed, nonetheless, this lesion is now amenable to timely surgical repair 13 . Anomalous origin of one or the other coronary artery from the pulmonary trunk can also be found when the heart itself is congenitally malformed.…”