Abstract
We report clinical, CT, invasive coronary angiography and intra-operative findings of a symptomatic elderly man with anomalous origin of left coronary artery from pulmonary artery (ALCAPA). ALCAPA is a rare syndrome with anomalous origin of left main coronary artery (LMCA) from main pulmonary artery (MPA). Survival into adulthood is rare and our case is probably the oldest survivor who has undergone two coronary system repairs for this anomaly. The unique features of our case include: 1) Absence of “q” wave myocardial infarction on ECG; 2) Absence of significant mitral regurgitation; 3) Demonstration of stress induced perfusion defects in nuclear imaging which as per our knowledge has been done for the first time in the literature; 4) A unique technique of closing anomalous LMCA origin by a pericardial patch, sutured on the internal aspect of MPA is the hallmark of this case.
Highlights
ALCAPA which was originally described by Brooks [1] is a very rare congenital defect which accounts for 0.5% of all the congenital heart defects [2]
LIMA was harvested and kept ready in case we find the length of LMCA inappropriate for mobilization
Most patients with ALCAPA (90%) die in 1st year of life because of shunting of blood from left coronary system into pulmonary artery leading to severe ischemia in LAD and circumflex territories
Summary
ALCAPA which was originally described by Brooks [1] is a very rare congenital defect which accounts for 0.5% of all the congenital heart defects [2]. (2014) Anomalous Origin of Left Coronary Artery from Main Pulmonary Artery (ALCAPA) Who Underwent Two Coronary System Repair with a Novel Technique. Open Journal of Clinical Diagnostics, 4, 182-191. C. Ponde et al with autopsy findings was described by Bland and Colleagues and called Bland White Garland (BWG) syndrome [4]. Ponde et al with autopsy findings was described by Bland and Colleagues and called Bland White Garland (BWG) syndrome [4] To our knowledge, this is the oldest patient who has undergone surgical repair for this anomaly
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