Subject(s)
Coronary Vessel Anomalies/history , Thoracic Surgery/history , Vascular Fistula/history , Vascular Surgical Procedures/history , Anniversaries and Special Events , Coronary Vessel Anomalies/surgery , History, 20th Century , History, 21st Century , Humans , Societies, Medical/history , United States , Vascular Fistula/surgery , Vascular Surgical Procedures/methodsABSTRACT
The landmark 1933 case report from Massachusetts General Hospital by Bland, White and Garland (Am Heart J 8:787-801) described a 3-month-old child with progressive feeding problems, cardiomegaly on chest radiography, and EKG evidence of left ventricular damage. Of interest was the fact that the vigilant father of the infant was Aubrey Hampton, a radiologist and future chairman of radiology at Massachusetts General Hospital. At autopsy, the left coronary artery originated from the pulmonary artery rather than from the aorta. Effective treatment for this condition was not available until 1960 when Sabiston, Neill and Taussig showed that the blood flowed from the left coronary artery toward the pulmonary artery. The anomalous left coronary artery was ligated at its junction with the pulmonary artery and the child survived. This historical review of Bland-White-Garland syndrome, now known as anomalous left coronary artery arising from the pulmonary artery (ALCAPA), stresses the continued diagnostic significance of cardiomegaly on chest radiography and EKG changes suggesting left ventricular damage in 2- to 3-month-old infants with feeding intolerance or irritability. With a high index of suspicion, an echocardiogram can be obtained to confirm the diagnosis. Modern surgical methods involve left coronary artery translocation and afford excellent outcomes.
Subject(s)
Coronary Vessel Anomalies/history , Diagnostic Imaging/history , Pulmonary Artery/abnormalities , Radiology/history , History, 20th Century , History, 21st Century , Massachusetts , SyndromeABSTRACT
A origem anômala das artérias coronárias é uma doença potencialmente letal, sobretudo em lactentes e atletas jovens. O entendimento da fisiopatologia da doença permitiu a diferenciação entre as diferentes apresentações clínicas. Apesar de ser causa de isquemia miocárdica, os exames indutores de isquemia podem ser normais. A cineangiocoronariografia foi durante muito tempo considerada o exame ideal para o diagnóstico da doença, mas os exames de imagem cardiovascular não-invasivos têm mostrado uma melhor definição da origem e do trajeto das artérias coronararias. O tratamento cirúrgico deve ser indicado em pacientes sintomáticos, principalmente em crianças com origem anômala da artéria coronária esquerda da artéria pulmonar. O manejo ideal para os pacientes assintomáticos permanece indefinido.
The anomalous origin of the coronary arteries is a potentially lethal pathology, especially in neonates and young athletes. The understanding of the pathophysiological pattern of the disease has allowed the recognition of the different forms of clinical presentation. Despite being a cause of myocardial ischemia, functional tests can be normal. Coronary angiography used to be the gold standard for the diagnosis of this pathology, but non-invasive cardiovascular imaging tests have shown better definition of the origin and course of coronary arteries. Surgical treatment should be indicated for symptomatic patients, mainly in children with the anomalous origin of the left coronary artery from the pulmonary artery. The ideal management of asymptomatic patients remains undefined.