Midterm results of left coronary artery reimplantation through the transverse sinus of the pericardium in adult Bland-White-Garland syndrome.

Go Kataoka,Shinji Sudo,Atsuhiko Sato,Ryota Asano,Kiyoharu Nakano,Wataru Tatsuishi,Kojiro Kodera

doi:10.1186/s40792-015-0027-3

Abstract

The anomalous origin of the left coronary artery from the pulmonary artery - known as Bland-White-Garland syndrome - is a rare congenital malformation that affects 1 in 300,000 live births. Most patients die in infancy without any surgical treatment. Some patients who survive past childhood often have varying symptoms such as myocardial ischemia, impaired left ventricular function, mitral regurgitation, and progressive heart failure, depending on the development collateral circulation. In the present report, we describe a procedure wherein the left coronary artery ostium was translocated through the transverse sinus of the pericardium in a 43-year-old mother with Bland-White-Garland syndrome and concomitant mitral regurgitation and report on the associated midterm results.

Highlights

The anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) occurs in 0.26% of patients with congenital heart disease
We describe a modified procedure for the translocation of the left coronary artery (LCA) combined with mitral annuloplasty in an adult with ALCAPA and concomitant mitral regurgitation (MR) and the associated midterm results
Multidetectorrow computed tomography (MDCT) indicated the development of collaterals between the right coronary artery (RCA) and the LCA, RCA dominance, and a hypoplastic circumflex artery (CX) and indicated that the LCA arose from the pulmonary trunk and that the dilated RCA originated from the appropriate sinus of Valsalva (Figure 1B)

Summary

Introduction

The anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) occurs in 0.26% of patients with congenital heart disease. Up to 90% of ALCAPA patients die during their first year of life because of left ventricular failure in cases where it is surgically corrected. Adult presentation of ALCAPA is rare but may occur in cases where a well-developed collateral circulation from the right coronary artery is formed.

Results

Conclusion