DOI: https://dx.doi.org/10.18203/2349-3291.ijcp20221859
Published: 2022-07-25

Computed tomography angiography in anomalous left coronary artery from pulmonary artery: a case series

Munish Guleria, Suryansh Arora, Ravindra Singh Jadon, Sana Sana, Pritam Yadav, Shreshtha Singh

Abstract


Anomalous left coronary artery from pulmonary artery (ALCAPA) is a rare congenital anomaly with a high rate of mortality in first year of life. It is one of the most common causes of cardiomyopathy and myocardial ischemia in children. In the present scenario, computed tomography (CT) coronary angiography is sufficient for the diagnosis of ALCAPA, eliminating the need of invasive angiography. CT coronary angiography performed in infants with suspicion of ALCAPA is technically challenging in terms of acquisition techniques, radiation protection and diagnostic interpretation. In this case series, we present five cases of ALCAPA diagnosed on CT coronary angiography. CT coronary angiography was able to delineate the anomalous origin of left coronary artery (LCA) from pulmonary artery in all cases. Anomalous LCA was noted to arise from posterior pulmonary sinus of pulmonary trunk in four cases and main pulmonary artery in one case. CT angiography also identified the extent of inter-coronary collateral vessels, left ventricular dysfunction and signs of pulmonary hypertension.

 


Keywords


ALCAPA, Coronary angiography, Congenital, Coronary anomalies, Paediatric

Full Text:

PDF

References


Szmigielska A, Roszkowska-Blaim M, Gołąbek-Dylewska M, Tomik A, Brzewski M, Werner B. Bland-White-Garland syndrome - a rare and serious cause of failure to thrive. Am J Case Rep. 2013;14:370-2.

Yau JM, Singh R, Halpern EJ, Fischman D. Anomalous origin of the left coronary artery from the pulmonary artery in adults: a comprehensive review of 151 adult cases and a new diagnosis in a 53-year-old woman. Clin Cardiol. 2011;34(4):204-10.

Oncel G, Oncel D. Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery: Diagnosis with CT Angiography. J Clin Imaging Sci. 2013;3:4.

Peña E, Nguyen ET, Merchant N, Dennie C. ALCAPA syndrome: not just a pediatric disease. Radiographics. 2009;29(2):553-65.

Gribaa R, Slim M, Ben Salem H. Anomalous origin of the left coronary artery from the pulmonary artery presenting as dilated cardiomyopathy: a case report. J Med Case Rep. 2014;8:170.

Ramjattan NA, Lala V, Kousa O. Coronary CT Angiography. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021. Available at: https://www.ncbi.nlm.nih.gov/books/NBK470279/. Accessed on 21 Jan, 2022.

Malakan Rad E. Anomalous origin of left coronary artery from pulmonary artery associated with pulmonary hypertension. Indian Heart J. 2014;66(6):700-3.

Grubstein A, Benjaminov O, Dayan DB, Shitrit D, Cohen M, Kramer MR. Computed tomography angiography in pulmonary hypertension. Isr Med Assoc J. 2008;10(2):117-20.

Lin B, Feng D, Wang F, Wang J, Xu C, Zhao H, Cheng Z. Diagnosis and treatment of 7 cases with anomalous left coronary artery from pulmonary artery. Int J Clin Exp Med. 2018;11(3):2721-9.

Erdinc M, Hosgor K, Karahan O. Repair of anomalous origin of the left coronary artery arising from right pulmonary artery with rolled-conduit-extended reimplantation in an adult. J Card Surg. 2011;26(6):604-7.