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[Abnormal origin of the left coronary artery. Pre- and postoperative hemodynamic and metabolic studies]
Insights
A rare congenital heart defect, anomalous left coronary artery from the pulmonary artery, was surgically corrected. While coronary steal resolved, left ventricular function did not improve, highlighting the importance of early intervention for myocardial damage.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Cardiac Surgery
Background:
- Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart defect.
- ALCAPA can lead to myocardial ischemia, left ventricular dysfunction, and heart failure, often presenting in infancy but occasionally diagnosed in adulthood.
- This condition results in coronary steal, where the left coronary artery receives deoxygenated blood from the pulmonary artery, compromising myocardial perfusion.
Observation:
- A 45-year-old asymptomatic male was incidentally diagnosed with ALCAPA during evaluation for electrocardiographic changes suggestive of anterior myocardial infarction.
- Coronary angiography revealed the left coronary artery originating from the pulmonary artery, associated with apical dyskinesia and impaired global left ventricular function.
- The patient underwent surgical correction involving closure of the anomalous ostium and saphenous vein aorto-left anterior descending artery bypass grafting.
Findings:
- The surgical procedure was performed without complications.
- Postoperatively, hemodynamic and coronary signs of myocardial ischemia regressed, indicating successful correction of the coronary steal phenomenon.
- Despite surgical correction, left ventricular function showed no improvement eight months after the procedure, suggesting established myocardial damage.
Implications:
- Early surgical intervention for ALCAPA is crucial to prevent irreversible myocardial damage and preserve left ventricular function.
- This case underscores the importance of considering rare congenital anomalies even in adult patients presenting with seemingly acquired cardiac conditions.
- Prompt diagnosis and surgical management of ALCAPA can effectively resolve coronary steal and improve coronary perfusion, but the extent of myocardial recovery depends on the duration and severity of preoperative ischemia.
Abstract:
The authors report the case of an asymptomatic 45 year old man in whom an abnormal origin of the left coronary artery was discovered fortuitously. Coronary angiography was carried out for electrocardiographic signs of anterior myocardial infarction and showed the left coronary artery arising from the pulmonary artery: there was apical dyskinesia with alteration of global left ventricular function. The ostium of the left coronary artery was closed and a saphenous vein aorto-left anterior descending artery bypass was performed. There were no complications. Left ventricular function has not improved 8 months after surgery. The haemodynamic and coronary signs of myocardial ischaemia demonstrated preoperatively regressed after surgery: the coronary "steal" caused by the malformation which led to poor perfusion of the territory of the left coronary artery has therefore been corrected by surgery. This procedure should be carried out as early as possible in order to limit extension of the myocardial lesions.