Reconstruction of anomalous left coronary artery from pulmonary artery in an adult patient: a case report

Abstract

Background Anomalous left coronary artery from the pulmonary artery is a congenital heart disease in which myocardial ischemia occurs within 1 year of birth. Adults have been reported to survive owing to the development of collateral perfusion from right coronary artery. In these cases, however, revascularization is necessary to prevent sudden cardiac death. Case presentation A 62-year-old female gradually started experiencing dyspnea during exercise. Coronary computed tomography revealed that the left coronary artery arose from the main pulmonary artery. The patient was subsequently diagnosed with adult-type, anomalous left coronary artery from the pulmonary artery. She underwent a surgery, in which a 6-mm vascular prosthesis was passed through the main pulmonary artery to anastomose the left coronary artery and ascending aorta. Conclusion Our reconstructive technique using vascular prosthesis is effective for anomalous left coronary artery from pulmonary artery in adults.

Remote ALCAPA Repair—Total Arterial Reconstruction Using Free Aortic Graft Technique

“…The anterior and remote origin of ALCAPA in this patient precluded reimplantation at anatomical position unless a long prosthetic tube graft is used. 2 If an anteriorly positioned LCA was rotated posteriorly, there would be risk of kink at the prosthetic graft and circumflex origin (Figure 2A). In addition to the remote origin, an ALCAPA that presented late is also associated with several technical caveats: (1) a large main pulmonary and (2) a large ectatic LCA (hence larger amount of autologous tissues were required for reconstruction).…”

“…The repair of late ALCAPA in adult is more technically challenging and the use of prosthetic interposition graft has been described. 2 However, the use of prosthetic tube, as in Cabrol procedure, is associated with risk of thrombosis and mortality. 2,3 In order to achieve a laminar flow, the newly constructed ostium and left main stem must be at least the size of the dilated LCA (diameter of 9.9 mm, with circumference of 31 mm).…”

“…2 However, the use of prosthetic tube, as in Cabrol procedure, is associated with risk of thrombosis and mortality. 2,3 In order to achieve a laminar flow, the newly constructed ostium and left main stem must be at least the size of the dilated LCA (diameter of 9.9 mm, with circumference of 31 mm). If there is inadequate autologous tissue, a size discrepancy with a narrower reconstructed neo-left main stem and a larger ectatic LCA would be subjected to the following mechanical disadvantages: (1) turbulent flow and endothelial shear stress and (ii) competitive retrograde flow from a large RCA.…”