A rare case of anomalous origin of the left main coronary artery in an adult patient

Pierre O Dionne,Nancy Poirier,Louis M Stevens,Samer Mansour,Jessica Forcillo,Carl Chartrand-Lefebvre,Nicolas Noiseux

doi:10.1186/1749-8090-8-15

Abstract

Anomalous origin of left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly that causes a left-to-right shunt via the coronary system, resulting in coronary steal. We report an unusual case of a healthy 48 years-old patient presenting with dyspnea on exertion and mild chest pain who underwent surgical correction of this rare anomaly. Multiple procedures have been proposed in adults with ALCAPA. Although re-implantation of the left main coronary artery (LMCA) to the aorta remains the most physiological correction for this anomaly, the combination of LMCA ligation and coronary artery bypass grafting provides a dual coronary flow system and is preferable when re-implantation is impossible.

Highlights

Anomalous origin of left coronary artery from the pulmonary artery (ALCAPA) is an uncommon congenital anomaly affecting 1/300,000 live births [1]
After mobilization of the proximal coronary vessels, the left main coronary artery (LMCA) was doubly ligated at its origin on the PA without signs of ischemia, but tissues were fragile and we found numerous small epicardial collaterals
Using the MediStim VeriQ flow meter, intra-operative saphenous vein graft (SVG) flow was measured at 117 ml/min. This exceptional case of a late presentation of ALCAPA was interesting from a clinical and imaging perspective and from a therapeutic standpoint. Since patients with this anomaly rarely survive past infancy without surgical correction, very few adult patients have been reported in the literature, especially after 40 years old

Summary

Introduction

Anomalous origin of left coronary artery from the pulmonary artery (ALCAPA) is an uncommon congenital anomaly affecting 1/300,000 live births [1]. Cardiac computed tomography angiography (CTA) with 3D reconstruction (Figure 1) demonstrated diffusely enlarged and tortuous coronary arteries, a normal RCA implantation into the right coronary aortic sinus and a left main coronary artery (LMCA) implantation site on the pulmonary artery (PA) which was anterior and to the left [see Additional file 1].

Results

Conclusion