Subject(s)
Heart Ventricles , Pulmonary Artery , Humans , Pulmonary Artery/abnormalities , Pulmonary Artery/diagnostic imaging , Heart Ventricles/abnormalities , Heart Ventricles/diagnostic imaging , Anomalous Left Coronary Artery/surgery , Anomalous Left Coronary Artery/diagnostic imaging , Male , Coronary Vessel Anomalies/diagnostic imaging , Coronary Vessel Anomalies/surgery , FemaleABSTRACT
CASE PRESENTATION: A 19-year-old pregnant woman at week 32 of gestation was referred to our clinic with progressive shortness of breath for the further evaluation and treatment of high-risk pregnancy. Her complaints had been existing since her childhood. Two years prior to her admission, she had been diagnosed with heart failure with preserved ejection fraction due to cardiomyopathy and associated pulmonary hypertension. The patient had no family history of any cardiac disease. She had never smoked or drunk alcohol. Her clinical condition had deteriorated progressively with the pregnancy.
Subject(s)
Anomalous Left Coronary Artery , Cardiomyopathies , Cardiovascular Surgical Procedures/methods , Heart Failure , Hypertension, Pulmonary , Postnatal Care/methods , Pregnancy Complications, Cardiovascular , Adult , Anomalous Left Coronary Artery/complications , Anomalous Left Coronary Artery/diagnostic imaging , Anomalous Left Coronary Artery/physiopathology , Anomalous Left Coronary Artery/surgery , Cardiac Catheterization/methods , Cardiomyopathies/complications , Cardiomyopathies/diagnosis , Cesarean Section/methods , Computed Tomography Angiography/methods , Dyspnea/diagnosis , Dyspnea/etiology , Echocardiography/methods , Female , Heart Failure/complications , Heart Failure/diagnosis , Heart Failure/physiopathology , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/physiopathology , Pregnancy , Pregnancy Complications, Cardiovascular/diagnosis , Pregnancy Complications, Cardiovascular/etiology , Pregnancy Complications, Cardiovascular/physiopathology , Pregnancy Complications, Cardiovascular/therapy , Pregnancy, High-Risk , Stroke Volume , Treatment OutcomeSubject(s)
Humans , Male , Middle Aged , Chest Pain/complications , Coronary Disease/congenital , Coronary Vessel Anomalies/pathology , Anomalous Left Coronary Artery/diagnostic imaging , Angiocardiography/methods , Magnetic Resonance Spectroscopy/methods , Death, Sudden/etiology , Incidental Findings , Myocardial Revascularization/methodsSubject(s)
Humans , Female , Adult , Coronary Sinus/pathology , Anomalous Left Coronary Artery/pathology , Anomalous Left Coronary Artery/diagnostic imaging , Hernia, Umbilical/surgery , Iliac Artery/pathology , Iliac Artery/diagnostic imaging , Time Factors , Echocardiography/methods , Cardiac Catheterization/methods , Clinical Evolution/methods , Arterio-Arterial Fistula/diagnostic imaging , Aftercare , Magnetic Resonance Angiography/methods , Echocardiography, Doppler, Color/methods , Electrocardiography , Computed Tomography Angiography/methodsABSTRACT
A 38-year-old female with anomalous left coronary artery from the pulmonary artery presented with refractory angina (Canadian Cardiovascular Society [CCS] class 4). Having failed two previous internal mammary artery grafts to the left anterior descending artery and with no percutaneous revascularization options, she underwent coronary sinus reducer implantation, which improved her symptoms (CCS 0), quality of life, and corresponded to an improvement in ischemia on myocardial perfusion scanning. This case report describes an unusual case of refractory angina in the context of congenital heart disease, illustrates the benefit of this novel hourglass-shaped stent in improving ischemia, quality of life, depression and anxiety, and highlights the importance of managing these patients in multidisciplinary teams.
Subject(s)
Angina Pectoris/surgery , Anomalous Left Coronary Artery/surgery , Coronary Sinus/surgery , Vascular Surgical Procedures/instrumentation , Adult , Angina Pectoris/diagnostic imaging , Angina Pectoris/physiopathology , Anomalous Left Coronary Artery/diagnostic imaging , Anomalous Left Coronary Artery/physiopathology , Coronary Angiography , Coronary Sinus/diagnostic imaging , Coronary Sinus/physiopathology , Female , Humans , Quality of Life , Stents , Treatment Outcome , Vascular Surgical Procedures/adverse effectsABSTRACT
OBJECTIVES: The purpose of this study was to identify the prevalence of dual left anterior descending artery and define the morphological features using coronary computed tomography angiography in order to raise awareness of dual left anterior descending artery among radiologists. MATERIALS AND METHODS: The radiologic reports of 1912 patients who underwent coronary computed tomography angiography at our institution were searched retrospectively for the presence of dual left anterior descending artery. Computed tomography images of patients with dual left anterior descending artery were then reviewed, and the morphological features of dual left anterior descending artery were evaluated. RESULTS: Dual left anterior descending artery was identified in 1.3% of the patients in this study population. Type 1 dual left anterior descending artery was the most common subtype (76%). Four additional cases that were not classified before were also detected. CONCLUSION: Dual left anterior descending artery has a variety of subtypes reported mostly as odd cases, and gaining diagnostic awareness of dual left anterior descending artery is more critical, rather than listing and counting the subtypes. With the widespread use of coronary computed tomography angiography, it has become essential for radiologists to have knowledge about dual left anterior descending artery, as it is vital, especially for surgical planning.
Subject(s)
Anomalous Left Coronary Artery/diagnostic imaging , Coronary Angiography , Adult , Aged , Aged, 80 and over , Anomalous Left Coronary Artery/classification , Anomalous Left Coronary Artery/epidemiology , Computed Tomography Angiography/statistics & numerical data , Coronary Angiography/statistics & numerical data , Female , Humans , Male , Medical Illustration , Middle Aged , Prevalence , Retrospective StudiesSubject(s)
Anomalous Left Coronary Artery/diagnostic imaging , Computed Tomography Angiography , Coronary Angiography , Coronary Sinus/diagnostic imaging , Anomalous Left Coronary Artery/physiopathology , Cardiac-Gated Imaging Techniques , Coronary Sinus/physiopathology , Electrocardiography , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Predictive Value of TestsSubject(s)
Abnormalities, Multiple/diagnostic imaging , Anomalous Left Coronary Artery/diagnostic imaging , Computed Tomography Angiography , Coronary Angiography , Coronary Vessels/diagnostic imaging , Multidetector Computed Tomography , Pulmonary Artery/diagnostic imaging , Vascular Malformations/diagnostic imaging , Abnormalities, Multiple/physiopathology , Abnormalities, Multiple/surgery , Anomalous Left Coronary Artery/physiopathology , Anomalous Left Coronary Artery/surgery , Coronary Vessels/physiopathology , Coronary Vessels/surgery , Humans , Infant , Predictive Value of Tests , Pulmonary Artery/abnormalities , Pulmonary Artery/physiopathology , Pulmonary Artery/surgery , Vascular Malformations/physiopathology , Vascular Malformations/surgerySubject(s)
Anomalous Left Coronary Artery/diagnostic imaging , Computed Tomography Angiography , Coronary Angiography , Myocardial Bridging/diagnostic imaging , Myocardial Ischemia/diagnostic imaging , Anomalous Left Coronary Artery/complications , Anomalous Left Coronary Artery/physiopathology , Anomalous Left Coronary Artery/therapy , Conservative Treatment , Female , Humans , Middle Aged , Myocardial Bridging/complications , Myocardial Bridging/physiopathology , Myocardial Bridging/therapy , Myocardial Ischemia/etiology , Myocardial Ischemia/physiopathology , Myocardial Ischemia/therapy , Predictive Value of TestsSubject(s)
Anomalous Left Coronary Artery/diagnostic imaging , Computed Tomography Angiography , Coronary Angiography , Coronary Sinus/diagnostic imaging , Coronary Stenosis/diagnostic imaging , Aged , Anomalous Left Coronary Artery/physiopathology , Anomalous Left Coronary Artery/surgery , Coronary Artery Bypass , Coronary Sinus/abnormalities , Coronary Sinus/physiopathology , Coronary Sinus/surgery , Coronary Stenosis/physiopathology , Coronary Stenosis/surgery , Humans , Male , Myocardial Perfusion Imaging , Predictive Value of TestsSubject(s)
Abnormalities, Multiple/diagnostic imaging , Anomalous Left Coronary Artery/diagnostic imaging , Computed Tomography Angiography , Coronary Angiography , Coronary Sinus/diagnostic imaging , Pulmonary Artery/diagnostic imaging , Vascular Malformations/diagnostic imaging , Abnormalities, Multiple/physiopathology , Adult , Anomalous Left Coronary Artery/physiopathology , Collateral Circulation , Coronary Circulation , Coronary Sinus/abnormalities , Coronary Sinus/physiopathology , Humans , Male , Predictive Value of Tests , Pulmonary Artery/abnormalities , Pulmonary Artery/physiopathology , Pulmonary Circulation , Vascular Malformations/physiopathologyABSTRACT
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.
Subject(s)
Anomalous Left Coronary Artery/diagnostic imaging , Bland White Garland Syndrome/diagnostic imaging , Anomalous Left Coronary Artery/surgery , Bland White Garland Syndrome/surgery , Cardiac Surgical Procedures , Electrocardiography , Failure to Thrive , Female , Humans , Infant , Pulmonary Artery/pathology , UltrasonographySubject(s)
Anomalous Left Coronary Artery/complications , Hemodynamics , Pulmonary Artery/abnormalities , Ventricular Dysfunction, Left/etiology , Ventricular Function, Left , Anomalous Left Coronary Artery/diagnostic imaging , Anomalous Left Coronary Artery/physiopathology , Anomalous Left Coronary Artery/surgery , Coronary Artery Bypass , Female , Humans , Ligation , Middle Aged , Pulmonary Artery/diagnostic imaging , Pulmonary Artery/physiopathology , Pulmonary Artery/surgery , Recovery of Function , Saphenous Vein/transplantation , Treatment Outcome , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Dysfunction, Left/physiopathologyABSTRACT
BACKGROUND: Anomalous origin of the left coronary artery (LCA) from the pulmonary artery (ALCAPA) is a rare congenital heart disease. Retrograde flow from the right coronary artery (RCA) through natural collaterals to the low-pressure main pulmonary artery causes extensive ischemia. Limited data concerning the extent of permanent myocardial damage and functional recovery after surgical repair in the long-term follow-up is available. AIM: Determination of the incidence of incipient myocardial dysfunction in ALCAPA patients in the long-term observation using tissue Doppler and speckle tracking echocardiography. METHODS AND RESULTS: Eighteen ALCAPA patients after surgical repair (at median age of 7 months, range 3-167) underwent echocardiographic examination after (median) 17 years. All but 4 patients in NYHA class II presented well at follow-up. No narrowing in proximal LCA was detected in color Doppler. The initial (pre-surgical) left ventricular (LV) ejection fraction of 33±17% almost normalized to 55±6%, but was lower than in the age, sex and body surface area matched control group: 62±5% (p<0.001). At follow-up, LV global longitudinal strain (LS): -15.8±3.3% vs -21.9±1.7%; right ventricular LS: -20.6±3.9% vs -24.9±4.6%; left atrial LS: 27.7±4.3% vs 41.0±11.5%; right atrial LS: 26.8±7.4% vs 44.0±7.9% and early pulsed wave to tissue Doppler mitral filling ratio (E/E'): 8.1±2.6 vs 5.8±1.3 were impaired in the ALCAPA population in comparison to the control group (p<0.01 for all comparisons). LV radial and circumferential strain did not differ between groups. Mean LS in the ALCAPA patients in the RCA region was -19.0±4.4%, while in the LCA region -13.8±7.3% (p<0.00001). CONCLUSIONS: Despite good clinical condition and normalized LV ejection fraction in ALCAPA patients after surgical repair in the long-term follow-up, the diastolic and longitudinal systolic function of all cardiac chambers remained impaired, especially in the LCA region. Lifelong surveillance of repaired ALCAPA patients is needed.
Subject(s)
Anomalous Left Coronary Artery/diagnostic imaging , Coronary Vessels/diagnostic imaging , Heart/diagnostic imaging , Pulmonary Artery/diagnostic imaging , Adolescent , Anomalous Left Coronary Artery/pathology , Anomalous Left Coronary Artery/physiopathology , Anomalous Left Coronary Artery/surgery , Case-Control Studies , Child , Child, Preschool , Coronary Vessels/pathology , Coronary Vessels/physiopathology , Coronary Vessels/surgery , Diastole , Echocardiography, Doppler, Color , Female , Heart/physiopathology , Humans , Infant , Male , Pulmonary Artery/pathology , Pulmonary Artery/physiopathology , Pulmonary Artery/surgery , Pulse Wave Analysis , Stroke Volume , SystoleABSTRACT
OBJECTIVE: Anomalous left main coronary artery (LMCA) with an intraconal course is a relatively rare form of anomalous aortic origin of a coronary artery (AAOCA) from the wrong sinus of Valsalva. There is currently a paucity of information regarding this entity. The purpose of this article is to review our surgical experience with repair of anomalous LMCA with an intraconal course. METHODS: This was a retrospective review of 12 patients with an anomalous LMCA and an intraconal course who underwent surgical repair. The median age at surgery was 15 years (range 2-47). The seven oldest patients all had preoperative symptoms of exertional chest pain and one also had exertional syncope. The five youngest patients had no preoperative symptoms. One of these patients had a hemodynamically significant ventricular septal defect and one patient was the sibling of a patient who had undergone repair of AAOCA. RESULTS: The 12 patients underwent surgical repair including unroofing of the myocardial bridge overlying the intraconal LMCA and a LeCompte procedure. There was no early or late mortality and there were no significant complications. All 12 patients have resumed normal, unrestricted activities. CONCLUSIONS: Twelve patients with an anomalous LMCA and intraconal course presented to our institution for treatment. Surgical repair was performed successfully in all 12, with resolution of symptoms in the 7 patients who were symptomatic preoperatively. These results suggest that the surgical treatment is safe and efficacious in patients with an anomalous LMCA and intraconal course.
Subject(s)
Anomalous Left Coronary Artery/surgery , Coronary Vessels/surgery , Vascular Surgical Procedures/methods , Adolescent , Adult , Anomalous Left Coronary Artery/diagnostic imaging , Child , Child, Preschool , Computed Tomography Angiography , Coronary Angiography , Coronary Vessels/diagnostic imaging , Echocardiography , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
Anomalous aortic origin of the left main coronary artery arising from the right coronary sinus with a trans-septal course are rare and pose surgical challenges not addressed by current techniques. Coronary artery bypass grafting, although a plausible solution, has an unacceptably high incidence of graft failure due to competitive flow. We describe a novel transconal approach to effectively unroof the trans-septal left main coronary artery.