Title:Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery
Diagnosed in Adulthood
Volume: 20
Author(s): Nanai Xie, Jingyan Liu, Heng Zhang, Yuhui Zhu and Wanling Ma*
Affiliation:
- Department of Radiology, The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen & Longgang
Distract People’s Hospital of Shenzhen, Shenzhen, 518172, China
Keywords:
An anomalous left coronary artery from the pulmonary artery, Computed tomography angiography, Left coronary artery, Pulmonary artery, Coronary, Adulthood.
Abstract:
Introduction:
An anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare heart malformation, with 90% of patients dying during the first
year of life. If the right coronary artery compensation and multiple collateral circulation are sufficiently established, the patient's myocardial
ischemia symptoms are mild and appear later, which is called the adult type ALCAPA.
Case Description:
A 42-year-old woman presented to our hospital with one-month history of the aggravation of active shortness of breath which gradually progressed
to nocturnal paroxysmal shortness of breath and cough. Admission physical examination suggested mild edema of both lower limbs. Transthoracic
echocardiography (TTE) showed that a small vessel shadow was abnormally connected to the pulmonary artery (PA), and moderate pulmonary
artery hypertension. Coronary computed tomography angiography (CTA) showed an anomalous origin of the left main coronary artery (LMCA)
dividing into the left anterior descending (LAD) and left circumflex (LCX) artery from the PA, with no clear connection to the left coronary sinus.
The right coronary artery (RCA) was significantly dilated and originated from the normal Valsalva sinus. It was accompanied by multiple
collateral circulations, most of which traveled anterior to the right ventricular free wall and anterior interventricular sulcus, and some emanated
from the posterior descending branch of the posterior interventricular sulcus and walked toward the posterolateral wall of the left ventricle.
Conclusion:
Coronary computed tomography angiography (CTA) can be used to visualize the abnormal origin and distribution of the coronary artery's course
and may be the first choice in the diagnosis of ALCAPA.
