Anomalous origin of the left coronary artery from the pulmonary trunk in a 45-year-old woman

Abstract

We report a rare case of anomalous origin of the left coronary artery from the pulmonary trunk in a 45-year-old woman. The approach and technique used for selective catheterization of an anomalous left coronary artery arising from the pulmonary trunk are described. Six years after diagnosis, echocardiography showed left ventricular disfunction, and surgical treatment was indicated again. The origin of the left coronary artery from the pulmonary trunk was closed, and the postoperative period was uneventful, with recovery of left ventricular function and disappearance of ischemic features on stress myocardial perfusion imaging with 99m Tc-sestamibi, performed 4 weeks after surgery

Evaluation of myocardial perfusion and function by gated single-photon emission computed tomography technetium-99m methoxyisobutylisonitrile in children and adolescents with severe congenital heart disease

“…Indeed, our gated SPECT 99m Tc-MIBI 2-day rest-stress study in two participants with ALCAPA revealed anterior wall ischemia and a decrease of poststress EF because of an increase in poststress ESV. In addition, the study confirmed limited perfusion in the myocardial segments typically involved in ALCAPA [26][27][28]. Gated SPECT 99m Tc-MIBI findings were deemed important for further clinical management.…”

“…The literature concerning the functional significance of ALCAPA evaluated by SPECT is limited to case reports mainly in adults [26][27][28]. Katsuragi et al [29] described two adults with ALCAPA and inferoposterior perfusion defect on thallium-201 myocardial SPECT and suggested the presence of coronary steal because of large RCA and significant shunt formation.…”

Anomalous Origin of the Left Coronary Artery from the Pulmonary Trunk: Late Diagnosis and Asymptomatic Evolution

“…1 Surgical intervention is always indicated in the presence of anomalous origin of LCA from the PT, although it is suspected that in patients with this anomaly, prone to sudden death, surgery cannot prevent such occurrence. 4 Literature data 9 show the effectiveness of LCA reimplantation in the aorta, or anastomosis between the left internal thoracic artery and the anterior descending coronary artery with LCA ligature.…”

“…It presents high mortality during the first years of life, but some patients may have their diagnosis only in adulthood. 4 The clinical evolution is very unspecific and variable due to the diversity of anatomical abnormalities, associated or not with other structural malformations. As a result, some patients with this anomaly may remain asymptomatic for many years.…”

Pharmacological Stress Echocardiography in Patients with Anomalous Origin of Left Coronary Artery in Pulmonary Trunk

“…Dessa forma, o suprimento sanguíneo da coronária esquerda dependerá da existência de colaterais provenientes da coronária direita 1 . Com o sucesso desse fenômeno observa-se o roubo de fluxo das coronárias e isquemia miocárdica tardia, podendo o paciente chegar à fase adulta 4 .…”