Evaluation of Anomalous Coronary Arteries from the Pulmonary Artery

Abstract

ObjectiveThis study evaluated clinical and diagnostic findings, treatment methods, and follow-up of cases of anomalous coronary arteries from the pulmonary artery.MethodsThe study included all cases diagnosed with anomalous coronary arteries from the pulmonary artery between January 2012 and January 2016. Data from patients’ demographic characteristics, electrocardiography, echocardiography, angiographic findings, operation, intensive care unit stay, and follow-up were evaluated.ResultsThe study included 12 patients (8 male, 4 female), 10 with anomalous left coronary artery from the pulmonary artery (ALCAPA) and 2 with anomalous right coronary artery from the pulmonary artery (ARCAPA). Median age at diagnosis was 4 months (range, 1 month - 10 years old) and median weight was 5.5 kg (range, 3-30 kg). The most common complaints were murmur (n=7) and respiratory distress (n=5). In 4 cases, the initial diagnosis was dilated cardiomyopathy. Electrocardiographs were pathologic in all cases. Echocardiographic examination revealed medium to severe mitral valve regurgitation in 4 cases and reduced (< 40%) ejection fraction in 6 patients. Of the 12 patients, 8 underwent direct implantation of the left coronary artery into the aorta, 2 underwent implantation of the right coronary artery into the aorta, and the remaining 2 underwent a Takeuchi procedure. There were no early mortalities. Median hospital stay was 20 days (range, 5-35 days). Median follow-up duration was 18 months (range, 5-36 months), and no cases required further surgery during follow-up.ConclusionsAnomalous coronary arteries from the pulmonary artery can be successfully repaired providing there is early diagnosis and effective, appropriate intensive care unit follow-up. Therefore, coronary artery origins should be evaluated carefully, especially in cases with dilated cardiomyopathies.

Current Strategies for the Management of Anomalous Origin of Coronary Arteries from the Pulmonary Artery

“…In rare cases where coronary collaterals develop well ], patients may grow asymptomatic; however, these patients may experience sudden death in adulthood [Jian-Yong 2010]. In cases that cannot be diagnosed, any increase in oxygen demand in the early infantile period causes depletion of the physiological reserve and this causes myocardial infarction, leading to ischemia or sudden cardiac arrest [Guzeltas 2017]. Subendocardial infarcts and ischemia of papillary muscles due to coronary ischemia may cause mitral valve insufficiency.…”

Thrombosis in the Surgically Corrected Anomalous Right Coronary Artery after Reimplantation in Aorta

“…ALCAPA represents approximately 0.5% of congenital heart diseases compared to 0.002% by ARCAPA. Both of these anomalies can be encountered at any age but ALCAPA tends to become symptomatic early in life and is therefore more frequently diagnosed in infancy and childhood while ARCAPA is usually seen in adolescents and adults [ 4 ]. Unlike ARCAPA, physiology of ALCAPA results in significant myocardial ischemia due to inadequate perfusion pressure and low oxygen saturation from the pulmonary artery circulation.…”

Cardiogenic shock in the context of newly diagnosed anomalous origin of the right coronary artery originating from the pulmonary artery: a case report

“…In contrast, anomalous origin of the left coronary artery from the pulmonary artery is more common with an incidence of 0.008% and is usually discovered early in life given its symptomatic nature, 2 with signs of ischaemia and heart failure as pulmonary vascular resistance normalizes during infancy, creating a left-to-right shunt and coronary steal physiology. 3 Prior to 1965, ARCAPA was uniformly diagnosed during surgery or autopsy.…”