Comprehensive intraoperative transesophageal echocardiography of anomalous left coronary artery from pulmonary artery: What to look for and where to look?

Abstract

Anomalous origin of left coronary artery from pulmonary artery (ALCAPA) accounts for 0.4% of the congenital heart diseases. Comprehensive 2D and 3D transesophageal echocardiographic imaging of a well-collateralized subset of ALCAPA is described. A nonstandard short-axis view of both aorta and pulmonary arteries showed the origin of left coronary artery from the posterior sinus of the pulmonary artery and right coronary artery in its usual position. Pulse-wave interrogation of the coronary arteries showed the direction of flow in opposite directions. Using the real time-3D, the en-face views of the origins of both coronaries were also demonstrated.

Intraoperative echocardiographic coronary artery imaging in congenital and acquired heart disease

“…23 Transoesophageal echocardiography has also been reported to be helpful with confirming the diagnosis of anomalous coronary artery origins from the opposite sinus 24,25 or from the pulmonary artery. 26 In the latter example, colour and pulse wave spectral Doppler were useful in assessing retrograde flow in the anomalous left coronary artery and the presence of septal collaterals. 26…”

“…26 In the latter example, colour and pulse wave spectral Doppler were useful in assessing retrograde flow in the anomalous left coronary artery and the presence of septal collaterals. 26…”