Abstract
BackgroundWe present a rare case of anomalous origin of the left coronary artery from the pulmonary artery syndrome in an elderly man, and we describe coronary computed tomographic angiographic imaging findings to improve diagnostic confidence for the evaluation of this uncommon coronary artery anomaly.Case presentationA 70-year-old Caucasian man came to our hospital with slight limitation of physical activity (New York Heart Association class II). He was asymptomatic for angina, syncope, and palpitations. Cardiac magnetic resonance imaging was performed after echocardiography because a hypertrophic cardiomyopathy was suspected; a plausible coronary artery anomaly was demonstrated as collateral evidence. Subsequently, coronary computed tomographic angiography showed the anomalous origin of left coronary artery from the pulmonary artery; the coronary vessels appeared markedly dilated and tortuous. Dilated intercoronary vessels along the epicardial surface of the heart and dilated bronchial arteries, corresponding to collateral pathways, were observed. Left ventricular hypertrophy, delayed subendocardial enhancement, and mitral insufficiency were better evaluated on magnetic resonance images. Invasive coronary angiography confirmed the main findings. Given the patient’s age and clinical performance, surveillance with medical management was considered appropriate, and surgical repair was avoided.ConclusionsConfidence with the anatomic pattern and clinical significance of this anomalous condition is necessary to improve cardiac imaging evaluation ability. In our patient, coronary computed tomographic angiography proved to be a reliable imaging approach, superior to invasive coronary angiography in terms of diagnostic performance and patient safety.
Highlights
We present a rare case of anomalous origin of the left coronary artery from the pulmonary artery syndrome in an elderly man, and we describe coronary computed tomographic angiographic imaging findings to improve diagnostic confidence for the evaluation of this uncommon coronary artery anomaly.Case presentation: A 70-year-old Caucasian man came to our hospital with slight limitation of physical activity (New York Heart Association class II)
Anomalous left coronary artery from pulmonary artery (ALCAPA) syndrome is a rare, hemodynamically significant congenital coronary artery anomaly affecting 1 per 300,000 live births, accounting for 0.25–0.5% of all congenital cardiac diseases [1]. It is extremely rare for ALCAPA syndrome to be diagnosed in an adult, because the natural history of this malformation mostly leads to death within the first year of life if untreated [2]
The patient was still symptomatic for dyspnea caused by slight physical activity (NYHA class II); an echocardiogram demonstrated stable chamber measures and ejection fraction, and mitral regurgitation. This case report describes a 70-year-old man who presented to our hospital with slight limitation during ordinary activity, and he was diagnosed with ALCAPA syndrome
Summary
Case presentation: A 70-year-old Caucasian man came to our hospital with slight limitation of physical activity (New York Heart Association class II) He was asymptomatic for angina, syncope, and palpitations. Case presentation A 70-year-old retired Caucasian man, a former electrical society employee, presented to our hospital with moderate dyspnea on exertion (slight limitation of physical activity; New York Heart Association [NYHA] class II). He was asymptomatic for anginal pain, palpitations, or syncope. His past medical history included well-controlled hypertension, inguinal hernioplasty, and right total hip replacement for arthritis secondary to hip dysplasia His family history revealed an unspecified heart condition in his father, who had died aged 55 years old.
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