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Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA
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Anomalous origin of the left main coronary artery from the right coronary artery with a preaortic course

Omer Yildiz, Kanber Ocal Karabay, Canan Akman

    Texas Heart Institute Journal
    |July 16, 2015
    PubMed

    Insights

    A rare congenital heart defect, anomalous left main coronary artery from the opposite sinus of Valsalva, can cause angina. This case highlights the importance of diagnosing and managing this dangerous coronary anomaly.

    Area of Science:

    • Cardiology
    • Congenital Heart Disease
    • Cardiac Imaging

    Background:

    • Anomalous origin of the coronary arteries is a rare congenital heart defect.
    • The interarterial course between the aorta and pulmonary artery poses a risk of coronary artery compression.
    • Stable angina pectoris is a common symptom that can be indicative of underlying coronary artery disease.

    Observation:

    • A 51-year-old woman presented with stable angina pectoris and Canadian Cardiovascular Society class II functional capacity.
    • Electrocardiogram during treadmill exercise test revealed significant ST-segment depression in inferolateral leads.
    • Coronary angiograms identified an anomalous origin of the left main coronary artery from the opposite sinus of Valsalva with an interarterial course.

    Findings:

    • The patient's symptoms and diagnostic findings were consistent with myocardial ischemia.
    • The anatomical abnormality, anomalous left main coronary artery origin, was confirmed via coronary angiography.
    • Despite the potentially dangerous nature of the anomaly, the patient declined further investigation.

    Implications:

    • This case underscores the importance of considering anomalous coronary artery origins in the differential diagnosis of angina, even in the absence of typical risk factors.
    • Accurate diagnosis through coronary angiography is crucial for risk stratification and management planning.
    • Further research is needed to optimize diagnostic and therapeutic strategies for this rare condition.

    Keywords:
    Angina pectoris/etiologycoronary vessel anomalies/classification/complications/diagnosis/radiography/therapy/ultrasonographydeath, sudden/prevention & controldiagnostic imaging/methodssinus of Valsalva/abnormalitiesultrasonography, interventional

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