Echocardiographic Diagnosis of Bland-White-Garland Syndrome in an Asymptomatic Adult

Abstract

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital defect and usually diagnosed within the first 2 months of life. Only 10% of patients survive to adulthood largely in part to the formation of extensive collaterals from the right to left coronary arteries. We present a case of ALCAPA diagnosed in an asymptomatic adult through a transthoracic echocardiogram (TTE). ( Level of Difficulty: Beginner. )

Bland White Garland syndrome with aneurysm and collaterals of coronary arteries in an Afghan girl: a case report.

“…BWGS is a highly uncommon congenital defect that affects 1 in 300 000 newborns. It typically manifests in infancy, 10% of children with this congenital defect survive to adulthood [ 5 ]. The anomaly is usually isolated but has occasionally been associated with other congenital heart defects such as patent ductus arteriosus, ventricular septal defect, tetralogy of Fallot, or coarctation of the aorta [ 7 ].…”

“…If collaterals are sufficient, symptoms may be absent or only mild. Adults might have no symptoms, but more frequently, they can have a variety of symptoms, including syncope, chest pain, and sudden death [ 2 , 4 , 5 ]. The final stage in late adulthood, involves an overloaded collateral artery that repeatedly experiences ischemia due to the steal phenomenon from the RCA to the LCA and pulmonary artery [ 9 ].…”

“…The final stage in late adulthood, involves an overloaded collateral artery that repeatedly experiences ischemia due to the steal phenomenon from the RCA to the LCA and pulmonary artery [ 9 ]. BWGS can be diagnosed through the use of computed tomography (CT) of the chest, coronary angiography, and echocardiography [ 3 , 5 ]. Surgery is suggested for BWGS as soon as possible [ 2 , 4 ].…”

“…When collaterals are adequate, symptoms can be absent or relatively minor, allowing growth into adulthood [ 2 , 3 ]. Adults can sometimes be asymptomatic or, more commonly, have a variety of symptoms such as syncope, chest pain, and sudden death [ 4 , 5 ]. Echocardiography, coronary angiography, and computed tomography (CT) of the chest are useful tools for the diagnosis of BWGS [ 3 , 5 ].…”

“…Adults can sometimes be asymptomatic or, more commonly, have a variety of symptoms such as syncope, chest pain, and sudden death [ 4 , 5 ]. Echocardiography, coronary angiography, and computed tomography (CT) of the chest are useful tools for the diagnosis of BWGS [ 3 , 5 ]. When possible, surgery is advised for patients with BWGS.…”