Abstract
Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) with preserved ventricular function is a rare congenital coronary artery anomaly when diagnosed in an adult patient and remains an important cause of sudden cardiac death. We report a 42-year-old patient with ALCAPA managed with intrapulmonary interruption of the left main coronary artery (LMCA) ostea and grafting of the LMCA with left internal mammary artery so as to restore antegrade coronary flow. This restores a dual-coronary-artery system and also allows antegrade blood flow as in a normal coronary artery to a large area of viable myocardium. This strategy is simple to accomplish and is more physiological in an anteriorly placed and dilated LMCA as seen in our case.
Highlights
A 42-year-old female was referred for surgical management of ALCAPA after having been evaluated for angina on exertion lasting for two months
Tread-mill test was positive for inducible ischemia and transthoracic echocardiogram showed mild mitral regurgitation and normal left ventricular function with no wall motion abnormalities
Multislice computerized tomography (CT) showed a dilated left main coronary artery (LMCA) entering the main pulmonary artery (MPA) along with a tortuous and markedly dilated right coronary artery arising from the aorta (Figure 1)
Summary
A 42-year-old female was referred for surgical management of ALCAPA after having been evaluated for angina on exertion lasting for two months. Multislice computerized tomography (CT) showed a dilated left main coronary artery (LMCA) entering the main pulmonary artery (MPA) along with a tortuous and markedly dilated right coronary artery arising from the aorta (Figure 1). (2014) Anomalous Left Coronary Artery from Pulmonary Artery with Good Ventricular Function in an Adult.
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