Anomalous origin of coronary arteries from pulmonary artery in adults: a case series

Abstract

Background Anomalous origin of a coronary artery from the pulmonary trunk is a small group of rare congenital anomalies present in up to 1% of the population. These patients, in absence of an adequate collateral supply, may present with congestive heart failure secondary to ischaemia, arrhythmia, or sudden cardiac death in up to 90% of cases within the first months of life. Case summary We present four cases diagnosed in adulthood over 10 years in two high-volume centres. The first patient presented with dyspnoea and orthopnoea. The second with chest pain and episodes of non-sustained ventricular tachycardia. The third patient presented during her third pregnancy with chest pain, palpitations, and arrhythmia (non-sustained ventricular tachycardia). The fourth patient presented with sudden cardiac death. Discussion In all cases with anomalous origin of coronary arteries, it is recommendable to consider surgical correction to avoid the progression of ischaemia, congestive heart failure, arrhythmia, and sudden death.

Anomalous origin of left main coronary artery from pulmonary artery: Patient characteristics and imaging associations on multidetector computed tomography angiography

“…As per literature, 80%-90% of the patients with adult ALCAPA may experience sudden cardiac death by 35-40 years of age, more common in male athletes due to physical exertion. 1,[16][17][18] However, the mean age in our series is quite high (highest 54 years), which could be attributable to the right dominant system and extensive collateral network.…”

An unusual association: Chronic coronary syndrome and Bland-White-Garland syndrome

“…Adults who develop heterocoronary collateral vessels can be asymptomatic. In the absence of collateral circulation, mortality is approximately 90% without prompt diagnosis and surgical repair 2,4 . Perfusion of the anterior wall depends on the collateral circulation of the RCA.…”

Cardiac imaging findings in anomalous origin of the coronary arteries from the pulmonary artery; narrative review of the literature

“…The most common type of anomalous coronary artery with connection to the pulmonary artery is the anomalous origin of a left coronary artery from the pulmonary artery (ALCAPA) with an incidence of 0.008% followed by ARCAPA (0.002%). Due to the higher oxygen demand of the left ventricle and bigger territory fed by the left coronary artery (LCA) symptoms appear early in life leading to early diagnosis, Myocardial ischemia and sudden cardiac death are also more common in ALCAPA for the same reason [ 29 , 31 ].…”