ABSTRACT
Objective: To explore the pathogenesis, clinical characteristics, diagnosis and treatment methods of anomalous origin of left coronary artery from pulmonary artery (A L C A P A), and to improve the clinicians'understanding of the disease. Methods: The clinical data of an adult patient with ALCAPA who had been misdiagnosed as endocardial fiborelastosis (E F E) were retrospectively analyzed; in the meanwhile, the related literatures were reviewed. Results: The patient admitted to hospital because of her intermittent precordial pain, chest tightness and shortness of breath, and suffered from more than 2 months, aggravated for 3 d. The patient was preliminarily diagnosed as cardiomyopathy (considering the great possibility of E F E), atrial fibrillation, N Y H A E. After treatment, paroxysmal retrosternal pain still occurred, and ventricular fibrillation occurred one time. Finally, the patient was diagnosed as ALCAPA by coronary artery CTA, and treated by coronary artery bypass grafting. After operation, the patient recovered well. Conclusion: ALCAPA is relatively rare, and its clinical manifestations lack specificity, so it is easy to misdiagnose. Coronary artery CTA is an effective diagnostic method, and operation is the first choice for its treatment.
ABSTRACT
Objective To explore the value of echocardiography in the diagnosis of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) in children.Methods The echocardiographic images of 14 patients with ALCAPA confirmed by operation and 18 patients with endocardial fibroelastosis (EFE) diagnosed by clinical were compared and analyzed.Results Both ALCAPA and EFE exhibited obvious dilated left ventricle,decreased left ventricular systolic function,thick endocardium and mitral regurgitation of different degree.The former additionally showed dilated right coronary artery(RCA) with normal origin,left coronary artery(LCA) emerging from the root or wall of the pulmonary artery(PA),the retrograde flow into PA in LCA and abundant collateral vessels in myocardium.However the later exhibited normal diameter of LCA and RCA and no collateral vessels.Conclusions Color Doppler echocardiography not only demonstrates left ventricular systolic function,endocardium,mitrial regurgitation and collateral vessels in myocardium,but also shows the origination and courses of LCA clearly,which provide exact informations to diagnose ALCAPA.The echocardiography can be used as a powerful tool of ALCAPA diagnosis and preoperative assessment.
ABSTRACT
Anomalous origin of left coronary artery from pulmonary artery (ALCAPA) is a rare congenital cardiovascular anomaly. The mortality rate among infants and children without operation has been eighty to ninety-five percents and few patients survive till teen-age or adulthood. This anomaly was detected during elective coronary angiogram in a 32 year-old female patient with atypical chest pain. Reversible ischemia was demonstrated on myocardial 201Tl-SPECT. Coronary angiogram revealed anomalous origin of left coronary artery from pulmonary artery.