Delayed diagnosis of anomalous origin of the left coronary artery 16 years after mitral valve replacement

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 often leads to ischemic mitral insufficiency due to impaired left ventricular perfusion.
• Mitral valve replacement is a common treatment for severe mitral insufficiency.

Observation:

• A 25-year-old woman presented with a history of mitral insufficiency of unknown cause in childhood, treated with mitral valve replacement.
• She was diagnosed with anomalous origin of the left coronary artery from the pulmonary artery.
• The patient had undergone mitral valve replacement 16 years prior to this diagnosis.

Findings:

• Successful left internal mammary artery (LIMA) bypass grafting was performed for ALCAPA.
• This surgical intervention addressed the underlying coronary anomaly contributing to myocardial ischemia.
• The patient's mitral insufficiency, previously treated surgically, was managed in conjunction with the ALCAPA repair.

Implications:

• This case highlights the potential long-term consequences of ALCAPA, including ischemic mitral insufficiency.
• It demonstrates the feasibility and success of LIMA bypass grafting in adult patients with ALCAPA, even years after initial cardiac surgery.
• The findings suggest that a comprehensive surgical approach, addressing both the coronary anomaly and its sequelae, is crucial for long-term patient outcomes.