Anomalous Origin of Left Coronary Artery from Pulmonary Artery in Adults

Abstract

Various techniques have been described for management of anomalous origin of the left coronary artery from the pulmonary artery presenting in adults. Three patients, 1 male and 2 females, aged 27-37 years, underwent transpulmonary pericardial patch closure with concomitant left internal thoracic artery anastomosis to the left anterior descending artery, under standard cardiopulmonary bypass, thus creating a two-coronary system. One patient had concomitant mitral valve repair. All 3 survived the operation. Postoperative angiography in 2 patients revealed good antegrade flow with decreased collaterals in one and competitive inhibition with increased collaterals in the other. This procedure is considered to be the safest and simplest in this subset of patients.

Intracoronary shunt use in an adult patient with Bland-White-Garland syndrome

“…Comprehension of the crucial role of early extubation and mobilization in the acceleration of wound healing besides the benefits of sufficient microvascular blood supply as well as edema reduction; application of topical negative pressure (Vacuum assisted closure method; VAC therapy) has been suggested with identification of the rapid closure of the wound via increase in granulation tissue. Being first used by Obdeijn et al for the treatment of PMS in 1999, VAC therapy has become popular in USA by Argenta and Morykwas in 1995 and in Europe in 1997 (1).…”

“…The anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA or Bland-White-Garland syndrome) is a rare congenital heart defect with an incidence of 1 in 300.000 live births (1). Although it is the most common congenital coronary artery anomaly comprising 0.24%-0.46% of all congenital cardiac anomalies, only 10% of patients survive to adulthood (1,2).…”

“…Although it is the most common congenital coronary artery anomaly comprising 0.24%-0.46% of all congenital cardiac anomalies, only 10% of patients survive to adulthood (1,2).…”

“…In untreated adult ALCAPA patients, sudden death secondary to myocardial ischemia and cardiomyopathy is seen with an incidence of 80-90% at a mean age of 35 years (1,2). Although establishing dual coronary circulation in childhood is a common practice, treatment of this anomaly in adult patients is controversial.…”

“…Although establishing dual coronary circulation in childhood is a common practice, treatment of this anomaly in adult patients is controversial. Among various treatment options, establishing dual coronary circulation seems to provide better survival and significant recovery in ventricular functions (1,3,4). We performed combined simple closure and coronary artery bypass procedure to establish dual coronary circulation.…”