Anomalous coronary artery with tetralogy of Fallot and aortopulmonary window

Aortopulmonary window with anomalous origin of the right coronary artery from the pulmonary trunk

Anomalous origin of coronary artery originating from the pulmonary artery in conjunction with the aorticopulmonary window (APW) is a rare but a significant anomaly in the era of congenital cardiac diseases. The occurrence of anomalous origin of the right coronary artery from the pulmonary artery among the associated anomalies is less than 5%. The severity of the clinical condition of these patients depends on the degree of left-right shunt and compromise of the pulmonary blood flow. We report surgical management of a case of a 45-day-old infant with APW, ventricular septal defect, and anomalous origin of coronary artery originated from the pulmonary artery.

Successful surgical correction of tetralogy of fallot associated with anomalous left coronary artery connection to pulmonary artery

Tetralogy of fallot is rarely associated with anomalous left coronary artery connection to main pulmonary artery. High index of suspicion is needed preoperatively to diagnose this association and treat successfully. We present a case of 9-year-old boy with the rare association of tetralogy of fallot and anomalous left coronary artery connection to pulmonary artery with a giant steal intercoronary collateral crossing right ventricular outflow tract who was treated successfully by single-stage surgical correction.

Anomalous origin of the right coronary artery from the pulmonary artery: surgical re-implantation into the aorta

Anomalous origin of the right coronary artery from the pulmonary artery is rare (only 200 cases have been reported in total), potentially life-threatening and with an uncertain prognosis. Patient characteristics are only available in half the reported cases. Easy to miss, anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is usually diagnosed in association with concomitant cardiac anomalies. Techniques for its correction are rarely discussed, but the restoration of a two-coronary system is optimal. We report details of the surgical repair of ARCAPA in a 17-year-old man to highlight important anatomical features.

Rare Case of Aortopulmonary Window With Anomalous Origin of Right Coronary Artery

A 5-month-old infant presented with a rare, congenital heart disease: aortopulmonary window with an anomalous origin of the right coronary artery from the aortopulmonary window. Using echocardiography and computed tomography, the exact diagnosis could only be ascertained retrospectively; however, cardiac catheterization and angiography confirmed the diagnosis, which led to elective open-heart surgery. The infant made a full recovery.

Pre-operative identification of an anomalous left coronary artery from the pulmonary artery in association with tetralogy of Fallot and an aortopulmonary window

A newborn baby girl was diagnosed with tetralogy of Fallot and an aortopulmonary window. At 3 weeks of age, the coexistent diagnosis of an anomalous left coronary artery from the pulmonary artery was made. Initial surgical intervention included a Takeuchi baffle of the left coronary artery, closure of the aortopulmonary window, and placement of a right Blalock-Taussig shunt. Complete repair was undertaken at 12 months of age. Close pre-operative assessment of the coronary arterial anomaly is crucial in patients with an aortopulmonary window and tetralogy of Fallot.

Anomalous origin of left coronary artery from the pulmonary trunk in a mildly symptomatic adult female

Anomalous origin of the left coronary artery from the pulmonary trunk, also known as Garland-Bland-White syndrome, is an extremely rare but potentially fatal congenital cardiovascular anomaly, and it often exists as an isolated condition. We hereby report an adult female who was admitted for mild chest discomfort and was accidentally diagnosed to have anomalous origin of the left coronary artery from the pulmonary trunk. This anomaly was simply repaired by using a bovine pericardial patch to obliterate the anomalous opening in the pulmonary trunk and a single coronary artery bypass graft. This report highlights the characteristic events of the anomaly in an adult with only mild symptoms.

Unusual cardiac associations with Tetralogy of Fallot-a descriptive study

We present a large single-center series (>2200 cases) operated for Tetralogy of Fallot (TOF). We analyzed the incidence of associated unusual and uncommonly described cardiac lesions and their diagnostic and therapeutic implications in TOF patients. This retrospective study was conducted by reviewing records of patients operated for TOF at a large tertiary care pediatric cardiac centre. From 2002 to 2008, a total of 2235 cases of TOF were evaluated with echocardiography, cardiac catheterization, and/or cardiac computed tomography followed by cardiac surgery. Known and well-described associations were excluded from the study. Unusual associations were tabulated. Several unusual associations having an incidence >0.1% were detected. These included subaortic membrane (1%), pulmonary venous abnormalities (0.5%), small left ventricle (0.5%), interrupted inferior vena cava (0.5%), mitral valve abnormalities (0.4%), hemitruncus (0.4%), tricuspid valve abnormalities (0.4%), biventricular dysfunction (0.3%), retroaortic innominate vein (0.3%), bicuspid aortic valve (0.2%), and pericardial effusion (0.2%). This series describes unusual, not previously routinely reported cardiac lesions associated with TOF that may affect management and should be sought on preoperative evaluation. We demonstrate that more unusual associations do exist in not infrequent numbers, i.e., a TET is not just a TET.

Anomalous Origin of the Right Coronary Artery From the Pulmonary Artery With Aortopulmonary Window

This report describes a rare case of anomalous origin of the right coronary artery from the pulmonary artery associated with a large aortopulmonary window in a 2-month-old boy. The right coronary artery was exposed to systemic pressure and carried fairly well-oxygenated blood to the myocardium. Closure of the aortopulmonary window alone could have caused acute myocardial ischemia. The purpose of this case report is to describe successful diagnosis and management of anomalous origin of the right coronary artery associated with an aortopulmonary window. The pathological findings and the physiological effects, clinical importance, and method of correction used are discussed.

Risks of extracorporeal membrane oxygenation in patients with coronary artery anomalies

Extracorporeal membrane oxygenation is widely used to support and rest the heart before or following repair of congenital cardiac lesions in children. The beneficial effects of extracorporeal membrane oxygenation for the failing myocardium are undisputed. It is often an automatic choice whenever the heart seems incapable of supporting the circulation. However, its use may prove detrimental in patients with coronary anomalies, as illustrated by the case reports presented here.

Pulmonary origin of circumflex artery in aortopulmonary window

An aortopulmonary window associated with an anomalous left circumflex coronary artery arising from the adjoining pulmonary sinus in a 4-kg baby boy was successfully repaired by re-routing with a pericardial patch.

Anomalous origin of left coronary artery from the right pulmonary artery in association with type III aortopulmonary window and interrupted aortic arch

Anomalous origin of the left coronary artery from the pulmonary artery, also known as Garland-Bland-White syndrome, usually occurs as an isolated condition. We report an infant with caudal regression sequence diagnosed with interrupted aortic arch type B and type III aortopulmonary window, who was found to have anomalous origin of the left coronary artery from the right pulmonary artery at surgical repair. Successful repair of the aortopulmonary window and interruption was performed with reimplantation of the left coronary artery into the ascending aorta. This report highlights the importance of closely assessing the coronary ostia in patients undergoing complex aortopulmonary window repair.