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Focus on echocardiographic and Doppler analysis of coronary artery abnormal origin from the pulmonary trunk with mild

Pierre-Yves Courand1, André Bozio, Jean Ninet

  • 1Department of Congenital Heart Disease, Louis Pradel Hospital, Hospices civils de Lyon, Lyon, France. pycourand@hotmail.com

Echocardiography (Mount Kisco, N.Y.)
|January 26, 2013
PubMed

Insights

Late presentation of abnormal coronary artery from the pulmonary artery (ACAPA) is rare but can cause sudden cardiac death. Diagnosis via echocardiography and Doppler, followed by aortic implantation, effectively restores dual coronary circulation and prevents myocardial ischemia.

Area of Science:

  • Cardiovascular Medicine
  • Pediatric Cardiology
  • Diagnostic Imaging

Background:

  • Abnormal coronary artery from the pulmonary artery (ACAPA) typically presents in infancy, causing severe heart failure.
  • Late ACAPA presentation is uncommon, characterized by collateral development, mild symptoms, and risk of sudden cardiac death.

Purpose of the Study:

  • To describe the clinical presentation, diagnostic imaging methods, and outcomes of patients with late ACAPA.
  • To evaluate the effectiveness of surgical intervention for late ACAPA.

Main Methods:

  • Retrospective review of a single-center database for patients diagnosed with ACAPA after one year of age.
  • Analysis of echocardiography and Doppler imaging findings, including direct and indirect signs of ACAPA.
  • Review of surgical outcomes and long-term follow-up data.

Main Results:

  • Ten patients with late ACAPA (1.1-64 years) were identified: 6 with ALCAPA and 4 with ARCAPA.
  • Echocardiography/Doppler revealed direct signs (abnormal ostium, retrograde flow) and indirect signs (collaterals, vessel dilatation).
  • Nine patients underwent successful aortic implantation, with all asymptomatic post-surgery except one requiring reoperation.

Conclusions:

  • Noninvasive cardiovascular imaging, particularly echocardiography and Doppler, can reliably diagnose late ACAPA.
  • Direct aortic implantation is an effective surgical strategy for establishing dual coronary circulation and preventing myocardial ischemia in late ACAPA.
Abstract

Keywords:
ALCAPAARCAPAanomalous coronary arterysurgery

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