The 64-Multislice Computed Tomogram Averts Misdiagnosis of an Anomalous Origin of the Left Main Coronary Artery

Abstract

A 38-year-old woman was discovered to have a systolic murmur for an unrelated complaint. Transesophageal echocardiography showed no atrial or ventricular septal defects, but multiple large collateral vessels in interventricular septum. The origin of left coronary artery was not seen at the expected site on the aortic root. The 64-multislice computed tomography confirmed the diagnosis of an anomalous origin of the left coronary artery from the pulmonary artery. Left coronary artery was revascularized with a saphenous vein graft with an uneventful recovery.Keywords Anomalous origin of the left coronary artery from the pulmonary artery Á Multislice Á Computed axial tomography During physical examination, a 38-year-old woman was found to have an asymptomatic systolic murmur. The electrocardiogram was normal, and the chest radiograph showed mild cardiomegaly. Transthoracic echocardiography showed a moderately decreased systolic function (ejection fraction = 35%), no mitral regurgitation, and multiple muscular ventricular septal defects (VSDs), i.e., a possible ''Swiss cheese'' VSD. In contrast, the transesophageal echocardiogram showed no atrial or ventricular septal defects; instead, there were multiple large collateral vessels in the interventricular septum. Because the origin of the left coronary artery (LCA) was not visualized, and to better clarify the anatomy, a contrast-enhanced 64-multislice computed tomogragraphy (MSCT) was performed. The tomogram showed a dilated and tortuous right coronary artery arising from the right sinus of Valsalva and giving off extensive collateral vessels coursing over the right ventricular wall, the interventricular septum, and the apex to the LCA that originated from the proximal main pulmonary artery (Fig. 1a-c). Therefore, the diagnosis of anomalous origin of the LCA from the pulmonary artery (ALCAPA) was confirmed. Technically, transfer of the LCA from the PA was not feasible; thus, the LCA coronary origin was oversewn and a saphenous vein graft from the aorta to the LCA was performed. The patient's postoperative course was uneventful.

Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery: Diagnoses and Surgical Results in 12 Pediatric Patients

“…In addition, advances in cardiac magnetic resonance and computed tomography might make these methods an alternative to catheterization when the diagnosis is in doubt. [22][23][24] Progress in diagnosis, surgical techniques, and postoperative care has yielded dramatic prognostic improvements in ALCAPA patients: mortality rates have declined from 90% to ≤20%. [25][26][27][28][29] We think that the best repair technique for ALCAPA is reimplantation of the LCA in the aortic root, and indeed this has produced results superior to those of other techniques.…”