1
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McCay N, Ramanayake H, Bates R, McGuinness J, Kenny D, Morrison L. ARCAPA in Pulmonary Atresia, Ventricular Septal Defect, and Major Aortopulmonary Collateral Arteries. JACC Case Rep 2024; 29:102318. [PMID: 38601840 PMCID: PMC11002800 DOI: 10.1016/j.jaccas.2024.102318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/07/2024] [Accepted: 03/06/2024] [Indexed: 04/12/2024]
Abstract
We report a case of anomalous origin of the right coronary artery from the pulmonary artery in a patient with pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries. The diagnosis was made during a proposed hybrid approach to stent the native right ventricular outflow tract, and an alternative surgical strategy was created.
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Affiliation(s)
- Nicola McCay
- Children’s Health Ireland, Crumlin, Dublin, Ireland
| | | | - Rachel Bates
- Children’s Health Ireland, Crumlin, Dublin, Ireland
- Royal Belfast Hospital for Sick Children, Belfast, Ireland
| | | | - Damien Kenny
- Children’s Health Ireland, Crumlin, Dublin, Ireland
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2
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Ahmed TM, Fishman EK. Anomalous right coronary artery originating from the pulmonary artery. Diagn Interv Imaging 2024; 105:206-207. [PMID: 38679539 DOI: 10.1016/j.diii.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/12/2024] [Accepted: 04/12/2024] [Indexed: 05/01/2024]
Affiliation(s)
- Taha M Ahmed
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
| | - Elliot K Fishman
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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3
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Guys N, Lippincott E, Frank L. NASCI case of the month: a case of anomalous right coronary artery arising from the pulmonary artery. Int J Cardiovasc Imaging 2024; 40:941-943. [PMID: 38594549 PMCID: PMC11052765 DOI: 10.1007/s10554-024-03091-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/11/2024]
Abstract
Coronary artery anomalies are rare but potentially fatal abnormalities with occasional striking imaging findings radiologists should recognize.
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Affiliation(s)
- Nicholas Guys
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Emily Lippincott
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Luba Frank
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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4
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Sreelal TV, Pandey NN, Kumar S, Ramakrishnan S. Anomalous origin of right coronary artery from pulmonary artery in a patient with tetralogy of Fallot. Acta Cardiol 2024; 79:238-239. [PMID: 37767900 DOI: 10.1080/00015385.2023.2259191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023]
Affiliation(s)
- T V Sreelal
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj Nirmal Pandey
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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5
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Li L, Yang H. Transoesophageal echocardiography of anomalous origin of the right coronary artery from the pulmonary artery. Eur Heart J Case Rep 2024; 8:ytae182. [PMID: 38665425 PMCID: PMC11044187 DOI: 10.1093/ehjcr/ytae182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/12/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024]
Affiliation(s)
- Lu Li
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37 Guoxue rode, Wuhou District, Chengdu 610041, China
| | - Hui Yang
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37 Guoxue rode, Wuhou District, Chengdu 610041, China
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6
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Ait Mokhtar O, Hamidouche K, Amini N, Boudjemline Y, Azzouz A, Benkhedda S. [Anomalous origin of right coronary artery from pulmonary artery associated to left main coronary stenosis]. Ann Cardiol Angeiol (Paris) 2024; 73:101737. [PMID: 38341990 DOI: 10.1016/j.ancard.2024.101737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 12/16/2023] [Accepted: 01/22/2024] [Indexed: 02/13/2024]
Abstract
We describe herein a case of a 16 years-old female patient referred to our department for further exploration of a chest pain. Color Doppler echocardiography revealed an abnormal flow at the level of the pulmonary artery. Exercise testing was abnormal leading to further imaging including computed cardiac tomography followed by coronary angiography which showed anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) associated with mid shaft left main stenosis. We discuss this uncommon association and therapeutic options.
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Affiliation(s)
- Omar Ait Mokhtar
- Mustapha University hospital, Algiers, Algeria; Cardiology oncology collaborative group, Algiers, Algeria.
| | | | | | | | - Abdelmalek Azzouz
- Mustapha University hospital, Algiers, Algeria; Cardiology oncology collaborative group, Algiers, Algeria
| | - Salim Benkhedda
- Mustapha University hospital, Algiers, Algeria; Cardiology oncology collaborative group, Algiers, Algeria
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7
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Molossi S, Doan T, Sachdeva S. Anomalous Coronary Arteries: A State-of-the-Art Approach. Card Electrophysiol Clin 2024; 16:51-69. [PMID: 38280814 DOI: 10.1016/j.ccep.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Congenital coronary anomalies are not an infrequent occurrence and their clinical presentation typically occurs during early years, though may be manifested only in adulthood. In the setting of anomalous aortic origin of a coronary artery, this is particularly concerning as it inflicts sudden loss of healthy young lives. Risk stratification remains a challenge and so does the best management decision-making in these patients, particularly if asymptomatic. Standardized approach to evaluation and management, with careful data collection and collaboration among centers, will likely impact future outcomes in this patient population, thus allowing for exercise participation and healthier lives.
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Affiliation(s)
- Silvana Molossi
- Coronary Artery Anomalies Program, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX 77030, USA; The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, MC E1920, Houston, TX 77030, USA.
| | - Tam Doan
- Coronary Artery Anomalies Program, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX 77030, USA; The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, MC E1920, Houston, TX 77030, USA
| | - Shagun Sachdeva
- Coronary Artery Anomalies Program, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX 77030, USA; The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, MC E1920, Houston, TX 77030, USA
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8
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Narvaez-Guerra OD, Sorour N, Aurigemma GP, Parker MW, Kanter DJ, Kovell LC. A Multimodality Imaging and Multidisciplinary Approach to Manage Anomalous Right Coronary Artery from the Pulmonary Artery in Pregnancy. CASE (PHILADELPHIA, PA.) 2024; 8:122-126. [PMID: 38524969 PMCID: PMC10954573 DOI: 10.1016/j.case.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
•ARCAPA can present with minimal symptoms. •A dilated RCA and intramyocardial collateralization are suspicious for ARCAPA. •CCT is the noninvasive diagnostic modality of choice to confirm ARCAPA. •Risk stratification of pregnant patients is key to preventing delivery complications.
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Affiliation(s)
- Offdan D. Narvaez-Guerra
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan School of Medicine, Worcester, Massachusetts
| | - Nouran Sorour
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan School of Medicine, Worcester, Massachusetts
| | - Gerard P. Aurigemma
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan School of Medicine, Worcester, Massachusetts
| | - Matthew W. Parker
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan School of Medicine, Worcester, Massachusetts
| | - David J. Kanter
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Massachusetts Chan School of Medicine, Worcester, Massachusetts
| | - Lara C. Kovell
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan School of Medicine, Worcester, Massachusetts
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Garncarz M, Wtorkowska W, Parzeniecka-Jaworska M, Krzemiński M, Machola D, Sienkiewicz K. Anomalous origin of the right coronary artery from the pulmonary artery in a Staffordshire Bull Terrier. J Vet Cardiol 2024; 52:28-34. [PMID: 38417388 DOI: 10.1016/j.jvc.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 01/28/2024] [Accepted: 02/04/2024] [Indexed: 03/01/2024]
Abstract
An asymptomatic 17-month-old, 18.5-kg, male Staffordshire Bull Terrier was referred due to a heart murmur. Examination revealed a grade 3/6 left apical systolic and right apical 3/6 heart murmur. Echocardiography showed volume overload of the left ventricle and mild systolic dysfunction with a left-right flow over the interventricular septal region. Cardiac gated computed tomography revealed anomalous origin of the right coronary artery from the pulmonary artery, an extensive network of collateral blood vessels connected the right and left coronary arteries, with bronchial and left intercostal arteries also connected to the network of collateral blood vessels, markedly enlarged right and left coronary arteries and left coronary sinus. With varied presentation, coronary anomalies are difficult to recognise and classify and to the best of our knowledge this is the first case of anomalous origin of the right coronary artery from the pulmonary artery diagnosis in the dog.
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Affiliation(s)
- M Garncarz
- Kardiowet, Grupy AK "Północ" 2 lok. U. 10, Warsaw, Poland.
| | - W Wtorkowska
- Kardiowet, Grupy AK "Północ" 2 lok. U. 10, Warsaw, Poland
| | - M Parzeniecka-Jaworska
- Kardiowet, Grupy AK "Północ" 2 lok. U. 10, Warsaw, Poland; Department of Small Animal Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska159c, 02-776 Warsaw, Poland
| | - M Krzemiński
- Krzemiński Veterinary Hospital, Łąkowa 35/38, 80-769 Gdańsk, Poland
| | - D Machola
- Krzemiński Veterinary Hospital, Łąkowa 35/38, 80-769 Gdańsk, Poland
| | - K Sienkiewicz
- Krzemiński Veterinary Hospital, Łąkowa 35/38, 80-769 Gdańsk, Poland; Department of Radiology, Gdańsk University Clinical Centre, Mariana Smoluchowskiego 17, 80-214 Gdansk, Poland
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10
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Molossi S, Doan T, Sachdeva S. Anomalous Coronary Arteries: A State-of-the-Art Approach. Interv Cardiol Clin 2024; 13:51-70. [PMID: 37980067 DOI: 10.1016/j.iccl.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Congenital coronary anomalies are not an infrequent occurrence and their clinical presentation typically occurs during early years, though may be manifested only in adulthood. In the setting of anomalous aortic origin of a coronary artery, this is particularly concerning as it inflicts sudden loss of healthy young lives. Risk stratification remains a challenge and so does the best management decision-making in these patients, particularly if asymptomatic. Standardized approach to evaluation and management, with careful data collection and collaboration among centers, will likely impact future outcomes in this patient population, thus allowing for exercise participation and healthier lives.
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Affiliation(s)
- Silvana Molossi
- Coronary Artery Anomalies Program, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX 77030, USA; The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, MC E1920, Houston, TX 77030, USA.
| | - Tam Doan
- Coronary Artery Anomalies Program, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX 77030, USA; The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, MC E1920, Houston, TX 77030, USA
| | - Shagun Sachdeva
- Coronary Artery Anomalies Program, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX 77030, USA; The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, MC E1920, Houston, TX 77030, USA
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11
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Garekar S, Sheth R, Patil S, Soni B, Malankar DP. Anomalous right coronary artery from the pulmonary artery in an infant with tetralogy of Fallot. Ann Pediatr Cardiol 2023; 16:459-462. [PMID: 38817264 PMCID: PMC11135895 DOI: 10.4103/apc.apc_169_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/14/2024] [Indexed: 06/01/2024] Open
Abstract
An anomalous right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital anomaly that does not have the typical presentation of the more common anomalous left coronary artery. We present an infant with tetralogy of Fallot with atypical findings on the preoperative echocardiogram. A cardiac computerized tomographic (CT) scan showed ARCAPA. This was confirmed intraoperatively and repaired successfully. Close attention to coronaries on echocardiography and a low threshold for additional imaging can successfully diagnose ARCAPA in the presence of additional congenital heart defects.
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Affiliation(s)
- Swati Garekar
- Department of Paediatric Cardiology, Fortis Pediatric and Congenital Heart Centre, Mumbai, Maharashtra, India
| | - Ronak Sheth
- Department of Paediatric Cardiology, Fortis Pediatric and Congenital Heart Centre, Mumbai, Maharashtra, India
| | - Sachin Patil
- Department of Pediatric Cardiac Anaesthesia and Critical Care, Fortis Paediatric and Congenital Heart Centre, Mumbai, Maharashtra, India
| | - Bharat Soni
- Department of Paediatric Cardiac Surgery, Fortis Pediatric and Congenital Heart Centre, Mumbai, Maharashtra, India
| | - Dhananjay P. Malankar
- Department of Paediatric Cardiac Surgery, Fortis Pediatric and Congenital Heart Centre, Mumbai, Maharashtra, India
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Chahal NK, Horak JG, Thalji NK, Augoustides JG, Garner CR, Bradshaw JD, Fernando RJ, Krishnan S, Desai RG, Patel KM. Left Coronary Artery Reimplantation for Repair of Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery in an Adult. J Cardiothorac Vasc Anesth 2023; 37:2098-2108. [PMID: 37516597 DOI: 10.1053/j.jvca.2023.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/31/2023]
Affiliation(s)
- Navdeep K Chahal
- Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Jiri G Horak
- Cardiothoracic and Critical Care Anesthesiology Sections, Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Nabil K Thalji
- Cardiothoracic Anesthesiology Section, Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - John G Augoustides
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Chandrika R Garner
- Department of Anesthesiology, Cardiothoracic Section, Wake Forest University School of Medicine, Winston Salem, NC
| | - John D Bradshaw
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston Salem, NC
| | - Rohesh J Fernando
- Department of Anesthesiology, Cardiothoracic Section, Wake Forest University School of Medicine, Winston Salem, NC.
| | - Sandeep Krishnan
- Adult Cardiothoracic Anesthesiology, Wayne State University School of Medicine, Pontiac, MI
| | - Ronak G Desai
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ
| | - Kinjal M Patel
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ
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Cera AJ, Mokha S, Sunderji S, Cortez D, Bautista GM. Acute Bowel Ischemia in a Premature Neonate with Miller-Dieker Syndrome and Anomalous Right Coronary Artery From the Pulmonary Artery. Pediatr Ann 2023; 52:e283-e291. [PMID: 37561828 PMCID: PMC10878796 DOI: 10.3928/19382359-20230613-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Miller-Dieker syndrome (MDS) is a rare disease characterized by type I lissencephaly, craniofacial dysmorphisms, intellectual disability, seizures, and death in early childhood. We report a case of a premature infant with MDS with an anomalous right coronary artery from the pulmonary artery who developed sudden bowel ischemia. This case prompts the reconsideration of cardiovascular involvement in patients with MDS. In addition, this review highlights key clinical features and reviews the critical manifestations of MDS that persist into childhood. [Pediatr Ann. 2023;52(8):e283-e291.].
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Molossi S, Doan T, Sachdeva S. Anomalous Coronary Arteries. Cardiol Clin 2023; 41:51-69. [DOI: 10.1016/j.ccl.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Liu B, Lalla S, Hothi SS, McAlindon E. Multimodal Imaging of an Incidental Anomalous Coronary Artery. CJC Open 2023; 5:161-163. [PMID: 36880073 PMCID: PMC9984881 DOI: 10.1016/j.cjco.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 11/13/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Boyang Liu
- Department of Cardiology, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom.,Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Sasha Lalla
- Department of Cardiology, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - Sandeep S Hothi
- Department of Cardiology, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom.,Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Elisa McAlindon
- Department of Cardiology, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
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Anomalous origin of coronary arteries from the pulmonary artery: A single-center experience. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:19-28. [PMID: 36926159 PMCID: PMC10012984 DOI: 10.5606/tgkdc.dergisi.2023.23396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 07/22/2022] [Indexed: 03/18/2023]
Abstract
Background The aim of the study was to evaluate the clinical and diagnostic findings, treatment, and follow-up of cases of anomalous origin of coronary arteries from the pulmonary artery. Methods Between January 1998 and June 2021, a total of 14 patients (5 males, 9 females; median age: 15 months; range, 3 to 156 months) diagnosed with anomalous origin of coronary arteries from the pulmonary artery were retrospectively analyzed. Demographic and clinical data of the patients, electrocardiographic, echocardiographic, angiographic, surgical, and follow-up findings were evaluated. Results The most common symptoms were respiratory distress (n=6) and murmur (n=3). With the exception of three cases, all other patients were diagnosed by echocardiography in the first examination. Severe mitral valve insufficiency was detected in four patients and four other patients had moderate mitral insufficiency on echocardiography. Ejection fraction values ranged between 38 and 79%. Eleven patients underwent direct implantation of the coronary artery into the aorta, and three underwent a Takeuchi procedure. Mortality occurred in only one case. After surgery, mitral insufficiency and ejection fraction values improved. Median follow-up was 62 (range, 5 to 170) months and all patients were asymptomatic, except one who required redo surgery. Conclusion Anomalous origin of the coronary arteries from the pulmonary artery is an uncommon congenital anomaly. Echocardiography is the main diagnostic tool. If all echocardiographic findings of the coronary anomaly are not investigated thoroughly, the diagnosis may be overlooked.
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Ajam A, Rahnamoun Z, Sahebjam M, Sattartabar B, Razminia Y, Ahmadi Tafti SH, Hosseini K. Cardiac imaging findings in anomalous origin of the coronary arteries from the pulmonary artery; narrative review of the literature. Echo Res Pract 2022; 9:12. [PMID: 36474265 PMCID: PMC9724414 DOI: 10.1186/s44156-022-00012-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare coronary artery malformation with an incidence of 0.002% in patients undergoing coronary angiography. It can lead to an increased risk of myocardial infarction (MI) and sudden cardiac death, even in asymptomatic patients. METHODS We conducted a review of published cases of ARCAPA using PubMed and Scopus databases and included patients over 18 years old with adequate echocardiographic data. RESULTS We evaluated 28 patients with ARCAPA with a mean age of 42.8 from 1979 to 2021. Patients were diagnosed mostly by angiography and echocardiography, the most performed treatment was reimplantation (15, 53.6%) and the main echocardiographic findings were dilated coronary arteries (9, 32.1%), coronary collaterals (8, 28.6%), and retrograde flow from right coronary arteries to main pulmonary trunk (7, 25%). CONCLUSION Although ARCAPA is rare and not as deadly as the anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) still there is a chance of serious outcomes, therefore surgical treatment should be performed upon diagnosis. Angiography is the gold standard for diagnosis, but echocardiography can be a convenient, non-invasive, and most reliable method as the primary step whenever ARCAPA is suspected.
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Affiliation(s)
- Ali Ajam
- grid.411705.60000 0001 0166 0922Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Rahnamoun
- grid.411705.60000 0001 0166 0922Department of Echocardiography, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sahebjam
- grid.411705.60000 0001 0166 0922Department of Echocardiography, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Sattartabar
- grid.411705.60000 0001 0166 0922Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran ,grid.411705.60000 0001 0166 0922Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Yasaman Razminia
- grid.411705.60000 0001 0166 0922Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Hossein Ahmadi Tafti
- grid.411705.60000 0001 0166 0922Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran ,grid.411705.60000 0001 0166 0922Research Center for Advanced Technologies in Cardiovascular Medicine, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Hosseini
- grid.411705.60000 0001 0166 0922Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Challenging Diagnosis of Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery. Diagnostics (Basel) 2022; 12:diagnostics12112671. [DOI: 10.3390/diagnostics12112671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Anomalous origin of the right coronary artery (RCA) from the pulmonary artery, ARCAPA, is an extremely rare congenital heart disease. Only 200 cases were reported from 1885 to the present. Patients diagnosed with ARCAPA can be either asymptomatic or can experience symptoms, such as heart murmur, dyspnea, or angina, shortly after birth or around 40–60 years of life. Usually, those with isolated ARCAPA are diagnosed later in life compared to those who associate other structural cardiac defects. We report two cases of anomalous origin of the right coronary artery at the level of the pulmonary artery trunk (ARCAPA) that were diagnosed by invasive coronary angiography. Although asymptomatic, general recommendations suggest an early corrective intervention to prevent complications such as myocardial ischemia and cardiac dysfunction, which can lead to sudden cardiac death.
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Xia SL, Tao HK, Ma L, Cui YQ, Zou MH, Li JR, Li FX, Li J, Zhang X, Chen XX. Pre-operative evaluation and mid-term outcomes of anomalous origin of the left coronary artery from the pulmonary artery based on left ventricular ejection fraction. Front Cardiovasc Med 2022; 9:961491. [PMID: 36017098 PMCID: PMC9395579 DOI: 10.3389/fcvm.2022.961491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 07/20/2022] [Indexed: 11/28/2022] Open
Abstract
Objective The purpose of this study was to evaluate the prognosis of patients with anomalous left coronary artery originating from pulmonary artery with varying cardiac function after surgical correction. Methods This was a single-center retrospective cohort study including 51 patients with anomalous left coronary artery originating from pulmonary artery, all of whom underwent surgery at our center. Results All 5 deaths occurred in the pre-operative low cardiac function group (n = 39). After corrected by body surface area, parameters such as left coronary artery, right coronary artery, left atrial diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, and main pulmonary artery diameter, were lower in patients in the normal cardiac function group than in the low cardiac function group. The rate of collateral circulation formation was higher in the normal cardiac function group. The proportion of changes of T wave was higher in the low cardiac function group (P = 0.005), and the duration of vasoactive drugs (dopamine, milrinone, epinephrine, nitroglycerin.) was longer in the low cardiac function group. Left ventricular end-diastolic diameter, left ventricular end-systolic diameter, main pulmonary artery diameter, and left atrial diameter were smaller than those pre-operatively (P < 0.05). Left ventricular ejection fraction was higher than that pre-operatively (P = 0.003). The degree of mitral regurgitation in the low cardiac function group was reduced post-operatively (P < 0.001). Conclusion There was a significant difference between the pre-operative baseline data of the low cardiac function group and the normal cardiac function group. After surgical repair, cardiac function gradually returned to normal in the low cardiac function group. The low cardiac function group required vasoactive drugs for a longer period of time. The left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left atrial diameter, and main pulmonary artery diameter decreased and gradually returned to normal after surgery. The degree of mitral regurgitation in the low cardiac function group was reduced after surgery.
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Affiliation(s)
- Shu-Liang Xia
- Department of Cardiovascular Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Hui-Kang Tao
- Department of Cardiovascular Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Li Ma
- Department of Cardiovascular Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Yan-Qing Cui
- Department of Cardiovascular Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Ming-Hui Zou
- Department of Cardiovascular Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Jian-Ru Li
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
- Department of Echocardiogram Room, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Feng-xiang Li
- Department of Cardiovascular Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Jia Li
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
- Clinical Physiology Laboratory, Guangzhou Women and Children's Medical Center, Institute of Pediatrics, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Xu Zhang
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
- Department of Pediatric Cardiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
- *Correspondence: Xu Zhang
| | - Xin-Xin Chen
- Department of Cardiovascular Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
- Xin-Xin Chen
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Talebian Yazdi M, Robbers-Visser D, van der Bilt IAC, Boekholdt SM, Koolbergen DR, Planken RN, Groenink M. Anomalous coronary artery from the pulmonary artery diagnosed in adulthood: a case series on variations of coronary anatomy and the diagnostic value of cardiac magnetic resonance imaging. Eur Heart J Case Rep 2022; 6:ytac345. [PMID: 36045648 PMCID: PMC9425847 DOI: 10.1093/ehjcr/ytac345] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/08/2022] [Accepted: 08/10/2022] [Indexed: 11/14/2022]
Abstract
Background Anomalous coronary artery from the pulmonary artery is a rare congenital disorder with high mortality rates in infancy. Adult cases can present with life-threatening arrhythmias and sudden cardiac death. Case summary We report three cases of adults with anomalous pulmonary origin of each of the main coronary branches. The first patient with an anomalous left coronary artery from the pulmonary artery presented with an out-of-hospital cardiac arrest. The second patient with an anomalous circumflex artery from the pulmonary artery was evaluated for a bicuspid aortic valve and a suspected coronary fistula but was otherwise asymptomatic. The third patient with an anomalous right coronary artery from the pulmonary artery presented with anginal symptoms. In all cases, the diagnosis was made by cardiac computed tomography or coronary angiography. Cardiac magnetic resonance imaging was performed in all patients to guide clinical decision making on surgical or non-invasive management. All patients underwent surgical repair. In two patients, a dual coronary artery system was restored by aortic reimplantation of the anomalous coronary artery. In one patient, aortic reimplantation was unsuccessful due to poor vessel quality and the anomalous coronary artery was ligated. Clinical follow-up during 1.8–9.7 years did not show any cardiovascular complications and all patients are currently alive and asymptomatic. Discussion Anomalous coronary artery from the pulmonary artery can have various clinical presentations in adulthood. Cardiac magnetic resonance imaging is a useful modality to guide selection of patients who might have symptomatic or prognostic benefit from surgical repair.
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Affiliation(s)
- Mehrdad Talebian Yazdi
- Department of Cardiology, Alrijne Hospital , Simon Smitweg 1, 2353 GA Leiderdorp , The Netherlands
| | - D Robbers-Visser
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam , Meibergdreef 9, 1105 BK Amsterdam , The Netherlands
| | - I A C van der Bilt
- Department of Cardiology, Haga Teaching Hospital , 2545 AA the Hague , The Netherlands
| | - S M Boekholdt
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam , Meibergdreef 9, 1105 BK Amsterdam , The Netherlands
| | - D R Koolbergen
- Department of Cardiothoracic Surgery, Amsterdam UMC, University of Amsterdam , Meibergdreef 9, 1105 BK Amsterdam , The Netherlands
| | - R N Planken
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Academic Medical Center, Amsterdam Cardiovascular Sciences, University of Amsterdam , 1105 AZ Amsterdam , The Netherlands
| | - M Groenink
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam , Meibergdreef 9, 1105 BK Amsterdam , The Netherlands
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21
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Pires CM, Antunes N, Bettencourt N, Marques J, Quina-Rodrigues C. Unmasking a Rare Disease: A Breathtaking Coronary Angiogram. Circ Cardiovasc Imaging 2022; 15:e013638. [PMID: 35345894 DOI: 10.1161/circimaging.121.013638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Nuno Antunes
- Department of Cardiology, Braga Hospital, Portugal
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22
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Ohashi K, Itagaki R, Mukaida T, Miyazaki K, Ohashi K, Kawada M, Abe D. Cardiac Arrest in a 33-year-old Marathon Runner with Anomalous Right Coronary Artery Originating from the Pulmonary Artery. Intern Med 2022; 61:673-677. [PMID: 34471018 PMCID: PMC8943370 DOI: 10.2169/internalmedicine.7612-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 33-year-old marathon runner presented with anomalous right coronary artery originating from the pulmonary artery after being admitted for cardiac arrest. Surgical re-implantation of the right coronary artery to the aortic root to re-establish right coronary ostial circulation was successful. The patient resumed exercise and required no further medical therapy.
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Affiliation(s)
- Koichi Ohashi
- Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, Japan
| | - Ryo Itagaki
- Department of Cardiovascular surgery, Tokyo Metropolitan Bokutoh Hospital, Japan
| | - Takuto Mukaida
- Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, Japan
| | - Kazuki Miyazaki
- Tertiary Emergency Medical Center (Trauma and Critical Care), Tokyo Metropolitan Bokutoh Hospital, Japan
| | - Keiko Ohashi
- Tertiary Emergency Medical Center (Trauma and Critical Care), Tokyo Metropolitan Bokutoh Hospital, Japan
| | - Masaaki Kawada
- Division of Pediatric and Congenital Cardiovascular Surgery, Jichi Children's Medical Center Tochigi, Japan
| | - Daisuke Abe
- Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, Japan
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23
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Tran A, Kochilas L, Thomas AS, Aggarwal V. Long-term outcomes after repair for anomalous right coronary artery from the pulmonary artery. Cardiol Young 2022; 33:1-5. [PMID: 35179109 PMCID: PMC9385887 DOI: 10.1017/s1047951122000373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Anomalous right coronary artery from pulmonary artery (ARCAPA) is a rare congenital heart disease that can lead to abnormal coronary perfusion and a need for surgical repair. Here, we report the outcomes of patients who underwent ARCAPA surgery within the Pediatric Cardiac Care Consortium (PCCC), a North American registry of interventions for paediatric heart diseases. We queried the PCCC for patients undergoing surgical repair for ARCAPA at <18 years of age between 1982 and 2003. Outcomes were obtained from the PCCC and after linkage with the National Death Index (NDI) and the Organ Procurement and Transplantation Network (OPTN) through 2019. Twenty-four patients (males: 15) were identified having surgery for ARCAPA at a median age of 5.8 (IQR 2.7-10.3) years. Of them, 23 cases were considered "simple" (without major intracardiac disease) and one "complex" (co-existing with tetralogy of Fallot). Five patients presented with symptoms [chest pain (1), dyspnoea on exertion (2) or history of syncope (2)]; while the remaining 19 patients were referred for evaluation of either murmur or co-existing CHD. There was no in-hospital mortality after the surgical repair. Fourteen patients had sufficient identifiers for NDI/OPTN linkage; among them, only one death occurred from unrelated non-cardiac causes within a median period of 19.4 years of follow-up (IQR: 18-24.6). Outcomes were excellent after reimplantation up to 25 years later and further longitudinal monitoring is important to understand the interaction of pre-existing coronary pathology with the effects of ageing.
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Affiliation(s)
- Andrew Tran
- Emory University School of Medicine, Atlanta, GA, USA
| | - Lazaros Kochilas
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Amanda S Thomas
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Varun Aggarwal
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
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24
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Sudden Cardiac Arrest in an Adult with Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA): Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031554. [PMID: 35162575 PMCID: PMC8834940 DOI: 10.3390/ijerph19031554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/23/2022] [Accepted: 01/28/2022] [Indexed: 11/29/2022]
Abstract
Introduction: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare coronary artery anomaly that carries 90% mortality in the first year of life when left untreated. The diagnosis of ALCAPA is rare in adulthood, and it includes a broad spectrum of clinical manifestations, including sudden cardiac death (SCD). Case report: We report a rare case of resuscitated sudden cardiac arrest in a 55-year-old female, who was diagnosed with ALCAPA and underwent successful surgical correction and implantable cardioverter defibrillator (ICD) implantation for secondary prevention. Discussion: ALCAPA diagnosis is not confined to childhood, and it represents a rare cause of life-threatening arrhythmias and SCD in the adult population. Surgical correction is recommended, regardless of age, presence of symptoms or inducible myocardial ischemia. Multimodality imaging is crucial for diagnosis, management planning and follow up. Assessment of the risk of recurrent ventricular arrhythmias, despite full revascularization, should be performed in all adults with ALCAPA. Myocardial scar detected via late gadolinium enhancement represents a potential irreversible substrate for ventricular arrhythmias, and it provides additional information to evaluate indication of an ICD for secondary prevention.
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25
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Adam EL, Generoso G, Bittencourt MS. Anomalous Coronary Arteries: When to Follow-up, Risk Stratify, and Plan Intervention. Curr Cardiol Rep 2021; 23:102. [PMID: 34196813 DOI: 10.1007/s11886-021-01535-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Coronary artery anomalies are a diverse group of entities, ranging from benign variations of normal anatomy to life-threatening conditions. There is, however, no universal consensus in their classification, risk stratification, and management. The aim of this review is to develop a straightforward clinical approach for the assessment and care of patients with anomalous coronary arteries. RECENT FINDINGS Autopsy series and population screening studies have recently provided useful clinical data on the prevalence and outcomes of coronary anomalies. Also, findings on coronary computed tomography angiography, magnetic resonance imaging, and invasive angiography, enriched with fractional flow reserve and intravascular ultrasound, have allowed identification of several high-risk features associated with specific coronary anomalies. Management of patients with anomalous coronary arteries requires an individualized approach based on clinical, physiological, and anatomic features. High-quality studies are paramount for further development of this fascinating field.
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Affiliation(s)
| | - Giuliano Generoso
- University Hospital, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Marcio Sommer Bittencourt
- University Hospital, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
- DASA, Sao Paulo, Brazil.
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26
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Kappel C, Chow J, Ahmed Z, Schwalm JD, Amin F. Cardiogenic shock in the context of newly diagnosed anomalous origin of the right coronary artery originating from the pulmonary artery: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab030. [PMID: 34113753 PMCID: PMC8186929 DOI: 10.1093/ehjcr/ytab030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/21/2020] [Accepted: 01/09/2021] [Indexed: 11/25/2022]
Abstract
Background Anomalous right coronary artery (RCA) from the pulmonary artery (ARCAPA) is a rare congenital heart abnormality with varying clinical presentations, for which multiple imaging modalities are often required for diagnosis. Case summary We present a case of a 76-year-old female presenting with 2 weeks of palpitations and shortness of breath who was found to be in rapid atrial fibrillation (AF) with congestive heart failure. Despite initial medical management, the patient developed cardiogenic shock with anuric renal failure. Emergent right and left heart catheterization did not demonstrate any significant obstructive coronary artery disease but showed severe right ventricular (RV) failure and raised the possibility of an ARCAPA. This diagnosis was further corroborated by findings on a subsequent transoesophageal echocardiogram. In view of profound decline and limited anticipated improvement, the patient ultimately decided to pursue comfort measures in a hospice setting. Discussion We postulate that the underlying aetiology of our patient’s shock state was multifactorial, notably progressive RCA-territory ischaemia and RV failure, sepsis, and new-onset uncontrolled AF. In adults, unrecognized congenital heart disease can uncommonly cause cardiogenic shock. In our case, echocardiography and invasive angiography were integrated for the diagnosis of ARCAPA given the clinical circumstances that limited the use of cardiac computed tomography angiography.
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Affiliation(s)
- Coralea Kappel
- Department of Medicine, McMaster University, 1200 Main Street West, Hamilton, ON L8S 4L8, Canada
| | - Justin Chow
- Department of Medicine, Division of Cardiology, McMaster University, 1200 Main Street West, Hamilton, ON L8S 4L8, Canada
| | - Zeeshan Ahmed
- Department of Medicine, Division of Cardiology, McMaster University, 1200 Main Street West, Hamilton, ON L8S 4L8, Canada
| | - Jon-David Schwalm
- Department of Medicine, Division of Cardiology, McMaster University, 1200 Main Street West, Hamilton, ON L8S 4L8, Canada.,Population Health Research Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Faizan Amin
- Department of Medicine, Division of Cardiology, McMaster University, 1200 Main Street West, Hamilton, ON L8S 4L8, Canada.,Department of Medicine, Division of Critical Care Medicine, McMaster University, 1200 Main Street West, Hamilton, ON L8S 4L8, Canada
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27
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Rizzo S, De Gaspari M, Frescura C, Padalino M, Thiene G, Basso C. Sudden Death and Coronary Artery Anomalies. Front Cardiovasc Med 2021; 8:636589. [PMID: 33869302 PMCID: PMC8044928 DOI: 10.3389/fcvm.2021.636589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/18/2021] [Indexed: 11/29/2022] Open
Abstract
Congenital coronary artery anomalies (CAA) include a wide spectrum of malformations present at birth with various clinical manifestations and degrees of severity. Patients may be asymptomatic, and CAA may be an incidental finding during cardiac imaging or at autopsy. However, in other cases, ischemia-related signs and symptoms, leading to an increased risk of sudden cardiac death (SCD), often as first presentation may occur. In this chapter, we discuss the normal anatomy of the coronary arteries (CA) and the pathology of CAA at risk of SCD, including our experience with victims of SCD among the young population (age <40 years) and among athletes.
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Affiliation(s)
- Stefania Rizzo
- Cardiovascular Pathology, Azienda Ospedaliera, Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Monica De Gaspari
- Cardiovascular Pathology, Azienda Ospedaliera, Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Carla Frescura
- Cardiovascular Pathology, Azienda Ospedaliera, Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Massimo Padalino
- Pediatric and Congenital Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Gaetano Thiene
- Cardiovascular Pathology, Azienda Ospedaliera, Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Cristina Basso
- Cardiovascular Pathology, Azienda Ospedaliera, Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padua, Padua, Italy
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28
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Salehi S, Suri K, Najafi MH, Assadi M, Hosseini Toudeshki EA, Sarmast Alizadeh N, Gholamrezanezhad A. Computed Tomography Angiographic Features of Anomalous Origination of the Coronary Arteries in Adult Patients: A Literature Review and Coronary Computed Tomography Angiographic Illustrations. Curr Probl Diagn Radiol 2021; 51:204-216. [PMID: 33526366 DOI: 10.1067/j.cpradiol.2020.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 12/13/2022]
Abstract
Computed tomography angiography not only detects atherosclerotic coronary artery disease but also helps delineate the anomalous coronary arterial anatomy that may be more than just an incidental finding and could contribute to patients' symptomatology. Additionally, identification of coronary artery anomalies is clinically significant for preoperative planning and optimizing the approach for coronary catheterizations or surgical treatments. In this work, we review rare origination anomalies of coronary arteries and illustrate their characteristics through computed tomography images.
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Affiliation(s)
- Sana Salehi
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA.
| | - Kabir Suri
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA
| | | | - Majid Assadi
- The Persian Gulf Nuclear Medicine Research Center, Bushehr University of Medical Science, Bushehr, Iran
| | | | | | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA
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29
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Teng P, Li W, Ni Y. Surgical treatment for anomalous origin of the right coronary artery from the pulmonary artery: a case report with five-year follow-up. J Cardiothorac Surg 2021; 16:3. [PMID: 33407633 PMCID: PMC7789775 DOI: 10.1186/s13019-020-01374-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/04/2020] [Indexed: 11/20/2022] Open
Abstract
Background Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital heart disease affecting about 0.002% of the population. Knowledge of ARCAPA is almost collected from case reports. The aim of this study was to provide a rare case to better understand this rare congenital coronary anomaly. Case presentation We report a rare case of an 18-year-old male who was initially referred because of heart murmur. Dilated and tortuous coronary arteries were detected by echocardiography and congenital coronary anomaly was suggested. Further coronary CT angiography confirmed the diagnosis of ARCAPA. Although dual coronary system provides favorable long-term outcome, bypass surgery was considered technically difficult due to the huge mismatch of caliber between the right coronary artery and graft vessels. Eventually, simple right coronary artery ligation was performed. The patient was followed up for about 5 years without evidence of atherosclerosis or myocardial ischemia. Conclusions ARCAPA presents as a rare congenital heart disease with variable clinical manifestations. Surgical treatment is highly recommended to re-establish dual coronary system and prevent further complications. To our best knowledge, only about 200 cases of ARCAPA has been reported.
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Affiliation(s)
- Peng Teng
- Department of Cardiovascular Surgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, Postal Address: 79#, Qingchun Road, Hangzhou, 310000, Zhejiang, China
| | - Weidong Li
- Department of Cardiovascular Surgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, Postal Address: 79#, Qingchun Road, Hangzhou, 310000, Zhejiang, China
| | - Yiming Ni
- Department of Cardiovascular Surgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, Postal Address: 79#, Qingchun Road, Hangzhou, 310000, Zhejiang, China.
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30
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Voleti S, Bukhari SM, Tongut A, Yerebakan C, Ito S, Loke YH. Anomalous Right Coronary Artery off the Pulmonary Artery Strikes When You Least Expect It! ACTA ACUST UNITED AC 2020; 5:110-114. [PMID: 33912779 PMCID: PMC8071823 DOI: 10.1016/j.case.2020.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Flow reversal in the right main coronary artery may indicate ARCAPA. Coronary artery origins must be confirmed by color Doppler imaging. Advanced imaging is indicated when coronary anatomy is equivocal by echocardiography.
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Affiliation(s)
- Sonia Voleti
- Cardiology and Cardiovascular Surgery, Children's National Hospital, Washington, District of Columbia
| | - Syed M Bukhari
- Cardiology and Cardiovascular Surgery, Children's National Hospital, Washington, District of Columbia
| | - Aybala Tongut
- Cardiology and Cardiovascular Surgery, Children's National Hospital, Washington, District of Columbia
| | - Can Yerebakan
- Cardiology and Cardiovascular Surgery, Children's National Hospital, Washington, District of Columbia
| | - Seiji Ito
- Cardiology and Cardiovascular Surgery, Children's National Hospital, Washington, District of Columbia
| | - Yue-Hin Loke
- Cardiology and Cardiovascular Surgery, Children's National Hospital, Washington, District of Columbia
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31
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Guenther TM, Sherazee EA, Wisneski AD, Gustafson JD, Wozniak CJ, Raff GW. Anomalous Origin of the Right Coronary Artery From the Pulmonary Artery: A Systematic Review. Ann Thorac Surg 2020; 110:1063-1071. [DOI: 10.1016/j.athoracsur.2020.01.082] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/06/2020] [Accepted: 01/31/2020] [Indexed: 10/24/2022]
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32
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Nishijima S, Nakamura Y, Ito Y, Kuroda M, Masuda T, Kobayashi K, Handa K, Ohigashi H, Sugiyama K, Kimura Y. Successful off-pump reimplantation of the anomalous right coronary artery from the pulmonary artery: A case report. J Cardiol Cases 2020; 22:68-71. [PMID: 32774523 DOI: 10.1016/j.jccase.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/01/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022] Open
Abstract
Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare occurrence that requires surgical repair, typically via cardiopulmonary bypass (CPB). In this study, we present the case of a patient with ARCAPA with a high risk of cerebral infarction and left main trunk stenosis. However, because of the high risk of cerebral infarction, CPB was no longer an option during surgical intervention. Instead, we performed off-pump reimplantation of the ARCAPA to the ascending aorta and coronary artery bypass grafting of the left coronary artery. The patient had an uneventful postoperative course. Based on the successful outcomes of this case, we suggest off-pump reimplantation of the ARCAPA to the ascending aorta as a useful alternative for patients who are not eligible to undergo CPB during surgical repair. <Learning objective Although surgical repair of the anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) usually requires cardiopulmonary bypass (CPB), we present a successful off-pump reimplantation for those who are not eligible to undergo CPB. We performed off-pump reimplantation of the ARCAPA to the ascending aorta and coronary artery bypass grafting of the left coronary artery. Therefore, we found off-pump reimplantation of the ARCAPA to the ascending aorta to be a useful alternative to CPB in high-risk patients.>.
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Affiliation(s)
- Shuhei Nishijima
- Department of Cardiovascular Surgery, Chibanishi General Hospital, Matsudo, Chiba, Japan
| | - Yoshitugu Nakamura
- Department of Cardiovascular Surgery, Chibanishi General Hospital, Matsudo, Chiba, Japan
| | - Yujiro Ito
- Department of Cardiovascular Surgery, Chibanishi General Hospital, Matsudo, Chiba, Japan
| | - Miho Kuroda
- Department of Cardiovascular Surgery, Chibanishi General Hospital, Matsudo, Chiba, Japan
| | - Takahiko Masuda
- Department of Cardiovascular Surgery, Chibanishi General Hospital, Matsudo, Chiba, Japan
| | - Kazuo Kobayashi
- Department of Cardiology, Kashiwa Municipal Hospital, Kashiwa, Chiba, Japan
| | - Keita Handa
- Department of Cardiology, Kashiwa Municipal Hospital, Kashiwa, Chiba, Japan
| | - Hirokazu Ohigashi
- Department of Cardiology, Kashiwa Municipal Hospital, Kashiwa, Chiba, Japan
| | - Koji Sugiyama
- Department of Cardiology, Kashiwa Municipal Hospital, Kashiwa, Chiba, Japan
| | - Yayoi Kimura
- Department of Cardiology, Kashiwa Municipal Hospital, Kashiwa, Chiba, Japan
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Anatomical and physiological assessment of a symptomatic anomalous origin of the right coronary artery from the pulmonary artery by noninvasive imaging examinations. J Cardiol Cases 2020; 22:72-76. [PMID: 32774524 DOI: 10.1016/j.jccase.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 11/24/2022] Open
Abstract
A 58-year-old female visited our hospital complaining of fatigue and repetitive pre-syncope during exercise. She had suffered with those symptoms for decades and had visited some hospitals where she did not get conclusive diagnosis. She was ultimately diagnosed as having subclinical ventricular septal defect unrelated to her symptoms. Echocardiography revealed normal ventricular function, but color Doppler showed multiple abnormal intramyocardial blood flow signals in ventricular septum and moderator band, which suggested abnormally developed coronary perfusion. Dilated left main trunk and abnormal color Doppler signal running into the main pulmonary trunk were also observed. Coronary computed tomography angiography revealed that right coronary artery originated from pulmonary artery and made connection to distal left anterior descending artery, which led to the final diagnosis of anomalous origin of the right coronary artery from the pulmonary artery. Exercise stress echocardiography showed wall motion abnormalities in inferior region which suggested ischemia in right coronary artery (RCA) territory. Her symptoms could be derived from the myocardial ischemia. She was referred to surgical intervention considering the possible risk of cardiac events including sudden death. Re-implantation of the abnormal RCA to the aorta was performed successfully. Her long-year persistent symptoms were completely alleviated, and repeat exercise stress echocardiography showed no evidence of ischemia. <Learning objective: We report an adult case of symptomatic anomalous origin of the right coronary artery from the pulmonary artery, who had not been given the correct diagnosis. Noninvasive diagnostic examinations including transthoracic Doppler echocardiography, exercise stress echocardiography and coronary computed tomography angiography contributed to the anatomical and physiological assessment of the rare congenital heart disease before and after the successful coronary re-implantation surgery.>.
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Anomalous origin of a single coronary artery from the pulmonary artery associated with patent ductus arteriosus. Cardiol Young 2020; 30:1043-1045. [PMID: 32508300 DOI: 10.1017/s1047951120001328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We report an unusual case of a 12-month-old boy diagnosed with anomalous origin of a single coronary artery from the pulmonary artery associated with patent ductus arteriosus. The patient survival was attributed to left-to-right shunt (patent ductus arteriosus) allowing for appropriate myocardial perfusion. Successful surgical correction involved patent ductus arteriosus closure, mitral annuloplasty and reimplantation of the coronary artery into the aortic root.
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Salahuddin A, Abbas SA, Zaidi AN. Anomalous Right Coronary Artery Arising from Pulmonary Artery in a Woman with Ventricular Dysfunction. Tex Heart Inst J 2020; 47:173-174. [PMID: 32603458 DOI: 10.14503/thij-16-6171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ayesha Salahuddin
- Montefiore Heart & Vascular Care Institute, Albert Einstein College of Medicine, Bronx, New York 10467
| | - Syed A Abbas
- Montefiore Heart & Vascular Care Institute, Albert Einstein College of Medicine, Bronx, New York 10467
| | - Ali N Zaidi
- Montefiore Heart & Vascular Care Institute, Albert Einstein College of Medicine, Bronx, New York 10467
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36
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Mantha Y, Feldman M, Assaf A, Harada R, Musselman D, Hieda M, Kawalsky D. Anomalous Origin of a Right Coronary Artery from the Pulmonary Artery in a Middle-Aged Woman. JACC Case Rep 2020; 2:464-467. [PMID: 34317265 PMCID: PMC8311615 DOI: 10.1016/j.jaccas.2020.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/05/2019] [Accepted: 01/06/2020] [Indexed: 11/22/2022]
Abstract
A 53-year-old female patient presented for evaluation of a murmur. The examination revealed a 2/6 systolic ejection murmur in the left upper sternal border. Transthoracic echocardiography with color Doppler showed increased blood flow around the apex of the right ventricle. Further imaging revealed the right coronary artery emerging from the pulmonary artery. (Level of Difficulty: Beginner.)
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Affiliation(s)
- Yogamaya Mantha
- Internal Medicine Department, Texas Health Presbyterian Hospital of Dallas, Dallas, Texas
| | - Mark Feldman
- Internal Medicine Department, Texas Health Presbyterian Hospital of Dallas, Dallas, Texas
| | - Andrew Assaf
- Internal Medicine Department, Texas Health Presbyterian Hospital of Dallas, Dallas, Texas
| | - Rakushumimarika Harada
- Internal Medicine Department, Texas Health Presbyterian Hospital of Dallas, Dallas, Texas
| | - David Musselman
- Cardiovascular Department, North Texas Heart Center, Dallas, Texas
| | - Michinari Hieda
- Internal Medicine Department, Texas Health Presbyterian Hospital of Dallas, Dallas, Texas.,Division of Cardiology, Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Darryl Kawalsky
- Cardiovascular Department, North Texas Heart Center, Dallas, Texas
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Frommelt P, Lopez L, Dimas VV, Eidem B, Han BK, Ko HH, Lorber R, Nii M, Printz B, Srivastava S, Valente AM, Cohen MS. Recommendations for Multimodality Assessment of Congenital Coronary Anomalies: A Guide from the American Society of Echocardiography: Developed in Collaboration with the Society for Cardiovascular Angiography and Interventions, Japanese Society of Echocardiography, and Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2020; 33:259-294. [PMID: 32143778 DOI: 10.1016/j.echo.2019.10.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Peter Frommelt
- Children's Hospital of Wisconsin and the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Leo Lopez
- Stanford University, Palo Alto, California
| | | | | | - B Kelly Han
- Children's Minnesota and the Minneapolis Heart Institute, Minneapolis, Minnesota
| | - H Helen Ko
- Kravis Children's Hospital, Mount Sinai Medical Center, New York, New York
| | - Richard Lorber
- Baylor College of Medicine, Children's Hospital of San Antonio, San Antonio, Texas
| | - Masaki Nii
- Shizuoka Children's Hospital, Shizuoka, Shizuoka, Japan
| | - Beth Printz
- University of California San Diego and Rady Children's Hospital, San Diego, California
| | | | - Anne Marie Valente
- Boston Children's Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Meryl S Cohen
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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38
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Hölscher M, Knirsch W, Dave H, Burkhardt BEU. Newborn girl with coarctation of the aorta and anomalous left coronary artery from pulmonary artery, with retrograde perfusion of left circumflex artery: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 3:1-4. [PMID: 31912005 PMCID: PMC6939823 DOI: 10.1093/ehjcr/ytz166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/14/2019] [Accepted: 09/08/2019] [Indexed: 11/20/2022]
Abstract
Background Anomalous left coronary artery from pulmonary artery (ALCAPA) is a rare coronary abnormality. Although it exists usually as an isolated abnormality, ALCAPA has been described with aortic pathologies like coarctation or aortopulmonary window. Case summary An 18-day-old female was admitted to the paediatric intensive care unit because of a heart murmur and weak femoral pulses. A transthoracic two-dimensional echocardiography was performed and confirmed suspected diagnosis of aortic coarctation. In addition, a total retrograde perfusion of the left circumflex coronary artery (LCX) was found, without visible flow through the ostium of the left coronary artery (LCA) into the aorta. A coronary angiography was performed, showing a single right coronary artery with a normal right posterior descending artery (RPD). Supplied by collaterals from the RPD, the LCX was perfused retrogradely, passing by the lateral wall of the ascending aorta without flowing into it, but into the right pulmonary artery. At 23 days of age, surgery was performed with resection of the aortic coarctation and reimplantation of the LCA into the posterior aortic wall. Discussion This case demonstrates that coronary artery anomalies like ALCAPA may occur together with other cardiac malformations. Despite concomitant cardiac lesions, careful assessment of the coronary arteries is mandatory, including cardiac catheterization in case of doubt.
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Affiliation(s)
- Martin Hölscher
- Pediatric Cardiology, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Walter Knirsch
- Pediatric Cardiology, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Hitendu Dave
- Department of Surgery, Pediatric Cardiovascular Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Barbara E U Burkhardt
- Pediatric Cardiology, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
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39
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Aortopulmonary window with anomalous right coronary artery from the pulmonary artery. Case report and literature review. Cardiol Young 2020; 30:47-49. [PMID: 31854282 DOI: 10.1017/s1047951119002543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Aortopulmonary window is a rare congenital heart lesion. It might be associated with other CHDs, as well as with anomalous origin of the coronary arteries. Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is the most commonly described coronary artery anomaly in association with aortopulmonary window. We are describing a premature neonate who was diagnosed to have aortopulmonary window and ARCAPA immediately after birth, and had a successful operation at the age of 4 months. This report highlights the importance of very careful assessment of the coronary arteries in patients with aortopulmonary window.
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40
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Sadoma D, Valente C, Sigal A. Anomalous Left Coronary Artery From The Pulmonary Artery (ALCAPA) as a Cause of Heart Failure. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1797-1800. [PMID: 31790381 PMCID: PMC6913289 DOI: 10.12659/ajcr.917655] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare anomaly. When present it can result in failure to thrive and congestive heart failure. CASE REPORT We present the case of a 6-month old female whose presentation was one of failure to thrive. Point of care ultrasound and electrocardiogram (ECG) were used to diagnose heart failure with consideration of ALCAPA. These tools helped to expedite transfer to a tertiary care center for definitive therapy. CONCLUSIONS Although a rare anomaly, ALCAPA induced heart failure can be quickly identified on bedside ultrasound. Together with ECG findings, the Emergency Physician can expedite the diagnosis and proper disposition.
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Affiliation(s)
- Daniel Sadoma
- Department of Emergency Medicine, Reading Hospital, West Reading, PA, USA
| | | | - Adam Sigal
- Department of Emergency Medicine, Reading Hospital, West Reading, PA, USA
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41
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Stefek BP, Imundo JR, Clark JB. Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery in a Neonate with Turner Syndrome and Aortic Arch Hypoplasia. Tex Heart Inst J 2019; 46:225-228. [PMID: 31708710 DOI: 10.14503/thij-17-6521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Anomalous origin of the right coronary artery from the pulmonary artery, a rare congenital cardiac defect, is typically not diagnosed during infancy. On the other hand, Turner syndrome is usually diagnosed early, and it is classically associated with bicuspid aortic valve and aortic coarctation. Individuals with Turner syndrome are also at increased risk for coronary artery anomalies. We present a case of anomalous right coronary artery from the pulmonary artery in a week-old neonate who also had Turner syndrome, patent ductus arteriosus, transverse aortic arch hypoplasia, and impaired ventricular function. Prostaglandin therapy through the ductus increased the patient's myocardial perfusion. Four months after corrective surgery, she was doing well. We discuss the reperfusion phenomenon in our patient's case, as well as other considerations in this combination of congenital defects.
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42
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Wang Y, Zhang Y, An Q. Woman With Sudden Cardiac Arrest. Ann Emerg Med 2019; 74:633-678. [PMID: 31668240 DOI: 10.1016/j.annemergmed.2019.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Yue Wang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yuchen Zhang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Qi An
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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43
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Furutachi A, Furukawa K, Komatsu A, Nogami E. A right coronary artery aneurysm 16 years after surgical repair of anomalous origin of the right coronary artery from the pulmonary artery. Interact Cardiovasc Thorac Surg 2019; 29:157-158. [PMID: 30689918 DOI: 10.1093/icvts/ivy356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/13/2018] [Accepted: 12/16/2018] [Indexed: 11/13/2022] Open
Abstract
Anomalous origin of the right coronary artery (RCA) from the pulmonary artery is a very rare congenital heart disease, and several reports have described long-term events after surgery. We report the case of a 46-year-old woman who underwent reimplantation of the RCA for anomalous origin of the right coronary artery from the pulmonary artery 16 years ago. An RCA aneurysm gradually developed and dilated over time, and we resected the aneurysm and also grafted the right gastroepiploic artery graft to the distal RCA. Careful long-term follow-up is required to avoid overlooking such a rare but life-threatening complication after surgical repair of anomalous origin of the right coronary artery from the pulmonary artery.
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Affiliation(s)
- Akira Furutachi
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Kojiro Furukawa
- Department of Cardiovascular Surgery, Kyushu Medical Center, Fukuoka, Japan
| | - Aiko Komatsu
- Department of Cardiology, Faculty of Medicine, Saga University, Saga, Japan
| | - Eijiro Nogami
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, Saga, Japan
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44
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Zucker EJ. Cross-sectional imaging of congenital pulmonary artery anomalies. Int J Cardiovasc Imaging 2019; 35:1535-1548. [PMID: 31175525 DOI: 10.1007/s10554-019-01643-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 05/31/2019] [Indexed: 02/06/2023]
Abstract
Congenital pulmonary artery (PA) anomalies comprise a rare and heterogeneous spectrum of disease, ranging from abnormal origins to complete atresia. They may present in early infancy or more insidiously in adulthood, often in association with congenital heart disease such as tetralogy of Fallot or other syndromes. In recent years, cross-sectional imaging, including computed tomography (CT) and magnetic resonance imaging (MRI), has become widely utilized for the noninvasive assessment of congenital PA diseases, supplementing echocardiography and at times supplanting invasive angiography. In this article, modern CT and MRI techniques for imaging congenital PA disorders are summarized. The key clinical features, cross-sectional imaging findings, and treatment options for the most commonly encountered entities are then reviewed. Emphasis is placed on the ever-growing role of cross-sectional imaging options in facilitating early and accurate diagnosis and tailored treatment.
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Affiliation(s)
- Evan J Zucker
- Department of Radiology, Stanford University School of Medicine, 725 Welch Road, Stanford, CA, 94305, USA.
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45
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Duggan J, Parker W, Reoma JL, Richey S, Huddleston C. Correcting a rare Congenital Coronary Anomaly in an Adult-A Case Report. World J Pediatr Congenit Heart Surg 2019; 11:244-246. [PMID: 31142195 DOI: 10.1177/2150135119828383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Anomalous origin of the right coronary artery from the pulmonary artery is an extremely rare condition with an uncertain natural history. Here, we present an otherwise healthy active duty service member who was found to have anomalous right coronary artery arising from the pulmonary artery as an incidental discovery during a workup for possible pulmonary embolus. We describe a preoperative workup which showed dilation of the coronaries and evidence of ischemia. Operative technique for restoration of a two-vessel coronary system is described. Postoperative imaging demonstrated reduction in the coronary dilation and resolution of ischemia.
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Affiliation(s)
- John Duggan
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - William Parker
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Junewai L Reoma
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Samuel Richey
- Saint Louis University School of Medicine, St Louis, MO, USA
| | - Charles Huddleston
- Division of Cardiothoracic Surgery, Saint Louis University School of Medicine, St Louis, MO, USA
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46
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Factors Associated With Adverse Outcomes After Repair of Anomalous Coronary From Pulmonary Artery. Ann Thorac Surg 2019; 108:785-791. [PMID: 31152733 DOI: 10.1016/j.athoracsur.2019.04.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/08/2019] [Accepted: 04/10/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Successful repair of anomalous origin of coronary artery from the pulmonary artery (ACAPA) is generally associated with a good prognosis. However, risk factors for poor postoperative outcomes have not been well characterized. This study used a multicenter data set to determine predictors of mortality after ACAPA repair. METHODS A retrospective analysis was performed using The Society of Thoracic Surgeons Congenital Heart Surgery Database's Participant User File. After identification of all patients with ACAPA who underwent repair from 2007 to 2016, demographics, preoperative and intraoperative variables, and postoperative complications were compared between survivors and nonsurvivors. The primary outcomes included (1) in-hospital mortality and (2) the need for postoperative extracorporeal membrane oxygenation (ECMO) support. Multivariable logistic regression was used to determine preoperative and intraoperative risk factors for these outcomes. RESULTS Of the 703 patients who underwent ACAPA repair, 20 (2.8%) died during the same hospitalization. The odds of mortality were increased if preoperative shock was present (odds ratio [OR], 4.6; 95% confidence interval [CI], 1.4 to 15.1; P = .01) and if postoperative ECMO was required (OR, 11.8; 95% CI, 3.6 to 38.4; P < .001). The odds of postoperative ECMO use were increased if preoperative shock was present (OR, 3.6; 95% CI, 1.6 to 7.6; P = .001). Lower weight was also a risk factor for both mortality and postoperative ECMO. CONCLUSIONS Lower weight, preoperative shock, and postoperative ECMO use were identified as risk factors for in-hospital mortality in patients undergoing ACAPA repair. These important perioperative factors likely reflect the clinical severity of presentation and suggest a role for early consideration of postoperative mechanical circulatory support to improve outcomes.
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47
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VanLoozen D, Bykhovsky MR, Kapoor D, Bates WB, Murdison KA, Polimenakos AC. Myocardial Ischemia and Anomalous Origin of the Right Coronary Artery From the Pulmonary Artery in the Adult: Management Implications and Follow-Up. World J Pediatr Congenit Heart Surg 2019; 12:139-141. [PMID: 31018762 DOI: 10.1177/2150135118816291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a very rare and potentially fatal congenital heart defect due to myocardial ischemia secondary to coronary steal phenomenon. We present a case of an adult presenting with a myocardial infarction who was found to have ARCAPA. Three-dimensional (3D) reconstructed computed tomography angiography (CTA) was utilized preoperatively for surgical planning. Surgical technique as well as pre- and postoperative 3D CTA are described and literature reviewed.
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Affiliation(s)
- Dennis VanLoozen
- Division of Pediatric Cardiology, Department of Pediatrics, Augusta University, Augusta, GA, USA
| | - Michael R Bykhovsky
- Division of Pediatric Cardiology, Department of Pediatrics, Augusta University, Augusta, GA, USA
| | - Deepak Kapoor
- Division of Cardiology, Department of Medicine, Augusta University, Augusta, GA, USA
| | - William B Bates
- Division of Radiology, Department of Medicine, Augusta University, Augusta, GA, USA
| | - Kenneth A Murdison
- Division of Pediatric Cardiology, Department of Pediatrics, Augusta University, Augusta, GA, USA
| | - Anastasios C Polimenakos
- Division of Pediatric and Congenital Cardiothoracic Surgery, Department of Surgery, Augusta University, Augusta, GA, USA
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48
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Ganta S, Vanderploeg M, Kavarana M. Repair of Anomalous Right Coronary Artery From the Pulmonary Artery Using the Modified Trapdoor Technique. World J Pediatr Congenit Heart Surg 2019; 10:192-196. [PMID: 30841828 DOI: 10.1177/2150135118822472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is rare. Unique anatomical characteristics observed include tethering secondary to the extensive collateral vessels, severe native coronary tortuosity, and massive dilation of the coronary arteries. This requires specific technical consideration to ensure safe translocation. METHODS A single-center retrospective review of six patients with ARCAPA was performed. Echocardiographic and computerized tomography scan data were analyzed for anatomical and functional cardiac characteristics. Operative techniques were analyzed, which reflected an evolution toward a modified-trapdoor technique. RESULTS Five children presented with asymptomatic murmurs and one adult patient with unstable angina. All patients underwent successful surgical correction. The modified trapdoor technique provided the most ideal geometry for coronary transfer secondary to its anatomical characteristics. Two patients had coronary button transfers above the sinotubular junction using vertical stab incisions, one had the button implanted after excising part of the aortic wall, and last three patients had modified trapdoor incisions. Mean cardiopulmonary bypass and cross-clamp times were 170 ± 27 minutes and 99.5 ± 29 minutes respectively. The average hospital stay was five days and there were no mortalities. CONCLUSIONS Anomalous right coronary from the pulmonary artery's unique anatomical characteristics require a coronary transfer technique different from that performed in aortic root replacement. In some respects, our modified technique resembles coronary transfers used in difficult arterial switch operations. The use of a modified trapdoor incision simplifies coronary transfer and may minimize coronary kinking and subsequent complications related to coronary transfer.
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Affiliation(s)
- Srujan Ganta
- 1 Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina Children's Hospital, Charleston, SC, USA
| | - Megan Vanderploeg
- 1 Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina Children's Hospital, Charleston, SC, USA
| | - Minoo Kavarana
- 1 Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina Children's Hospital, Charleston, SC, USA
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49
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Wu LP, Zhang YQ, Chen LJ, Liu YQ. Diagnosis of anomalous origin of the right coronary artery from the pulmonary artery by echocardiography. J Med Ultrason (2001) 2019; 46:335-341. [PMID: 30790093 DOI: 10.1007/s10396-019-00933-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 01/07/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To review the imaging characteristics and evaluate the diagnostic value of echocardiography for diagnosing anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA). METHODS We retrospectively reviewed the echocardiographic records and compared these images with operative findings in six children with ARCAPA. RESULTS ARCAPA was characterized by dilation of the left coronary artery, inappropriate origin of the right coronary artery from the pulmonary artery, and collaterals within the interventricular septum. The associated malformations included atrial septal defect in four cases. Four of six cases were diagnosed correctly, while the remaining two cases were misdiagnosed: one of fistula between the pulmonary artery and the left coronary artery and another of ARCAPA diagnosed intraoperatively in one case of atrial septal defect. CONCLUSION ARCAPA can be diagnosed by echocardiography but is prone to misdiagnosis. This malformation should be distinguished from coronary artery fistula.
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Affiliation(s)
- Lan-Ping Wu
- Department of Pediatric Cardiology, Shanghai Children'S Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, People's Republic of China
| | - Yu-Qi Zhang
- Department of Pediatric Cardiology, Shanghai Children'S Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, People's Republic of China.
| | - Li-Jun Chen
- Department of Pediatric Cardiology, Shanghai Children'S Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, People's Republic of China
| | - Yi-Qing Liu
- Department of Pediatric Cardiology, Shanghai Children'S Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, People's Republic of China
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Anomalous Origin of a Right Coronary Artery from Pulmonary Artery. Case Rep Cardiol 2019; 2018:2583918. [PMID: 30662773 PMCID: PMC6313962 DOI: 10.1155/2018/2583918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/18/2018] [Accepted: 12/09/2018] [Indexed: 12/05/2022] Open
Abstract
Congenital defects of the coronary arteries are noted in 0.2–1.4% of the general population. The first case of an anomalous origin of right coronary artery from pulmonary artery (ARCAPA) was described by Brooks in 1885. ARCAPA has an overall incidence of 0.002% in the general population. Most of the cases are asymptomatic; however, it can lead to serious complications such as heart failure, ischemia, and sudden death. A 57-year-old man presented to the cardiologist's office with complaints of shortness of breath and fatigue. The patient also had a previous history of coronary stents and heart failure. Initially, he was evaluated with a stress test which was reported as abnormal. The patient then underwent an invasive coronary angiography that revealed anomalous origin of the right coronary artery (RCA) and multivessel disease. Cardiothoracic surgery evaluated the patient and coronary artery bypass graft was performed. During the surgery, the anomalous origin of RCA from the pulmonary artery was identified and was successfully corrected by reimplanting the RCA into the ascending aorta. The anomalous origin of RCA is a rare yet life-threatening condition. The RCA due to its location of origin from the pulmonary artery tends to be a low-pressure vessel with a very thin and fragile wall. It also serves as a retrograde venous conduit from the left coronary circulation into the pulmonary artery. This connection results in a left-to-right shunt that explains the increase in oxygen saturation in the pulmonary artery and the high cardiac output which is normally seen in these cases. The clinical presentation can vary from coronary ischemia to heart failure or sudden death. Therefore, surgical correction is recommended even in asymptomatic patients. We present a case of an anomalous origin of RCA from the pulmonary artery which, unlike the origin of left coronary from pulmonary artery, is very rare. Patients with this condition should have early correction even if they are asymptomatic in order to prevent long-term complications.
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