Anomalous left coronary artery from pulmonary artery
Gopal Chandra Ghosh1, John Jose1, Kunal Gururani2 1 Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India 2 Department of Cardiology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
Date of Web Publication
Correspondence Address: Dr. Gopal Chandra Ghosh Room No. 310, Hospital Annexe, Christian Medical College and Hospital Campus, Ida Scudder Road, Vellore - 632 004, Tamil Nadu India
Source of Support: None, Conflict of Interest: None
How to cite this article: Ghosh GC, Jose J, Gururani K. Anomalous left coronary artery from pulmonary artery. Heart Views 2019;20:126-7
A 24-year-old homemaker presented with exertional angina of Canadian Cardiovascular Society Class I for 6 months. Her childhood was uneventful and clinical examination was unremarkable. Echocardiography revealed normal left ventricular function, absent left coronary artery (LCA) origin from aortic sinus, and a normal origin of a dilated right coronary artery (RCA) with torrential flow [Figure 1] and [Video 1]a. Significant collateral flow was noted in the interventricular septum [Video 1]b. Coronary angiography confirmed the absence of the LCA origin from aortic sinus [Figure 2]a and [Video 2]a and dilated collaterals in the interventricular septum are retrogradely supplying the LCA from the RCA [Video 2]b, which is draining into the main pulmonary artery [Figure 2]b and [Video 2]c.
Figure 1: Parasternal long axis view showing dilated right coronary artery
Figure 2: (a) Aortic root angiogram, left anterior oblique view showing absent left coronary artery origin from aortic sinus. (b) Selective right coronary angiogram, right anterior oblique view showing retrograde filling of left coronary artery from the right coronary artery through dilated septal collaterals
Eighty-five percentage of anomalous LCA from the pulmonary artery (ALCAPA) patients become symptomatic in their first two months of life. In adult age, ALCAPA can present with heart failure, mitral regurgitation, arrhythmic episodes, and also with angina or sudden cardiac death. Our case highlights that ALCAPA can be considered as a differential diagnosis of angina with preserved ventricular function in a young lady. Echocardiography with intent to look for coronary origins will help in early diagnosis.
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The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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