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Evaluation of Anomalous Coronary Arteries from the PulmonaryArtery

View Article: PubMed Central - PubMed

ABSTRACT

Objective: This study evaluated clinical and diagnostic findings, treatment methods, andfollow-up of cases of anomalous coronary arteries from the pulmonaryartery.

Methods: The study included all cases diagnosed with anomalous coronary arteries fromthe pulmonary artery between January 2012 and January 2016. Data frompatients’ demographic characteristics, electrocardiography,echocardiography, angiographic findings, operation, intensive care unitstay, and follow-up were evaluated.

Results: The study included 12 patients (8 male, 4 female), 10 with anomalous leftcoronary artery from the pulmonary artery (ALCAPA) and 2 with anomalousright coronary artery from the pulmonary artery (ARCAPA). Median age atdiagnosis was 4 months (range, 1 month - 10 years old) and median weight was5.5 kg (range, 3-30 kg). The most common complaints were murmur (n=7) andrespiratory distress (n=5). In 4 cases, the initial diagnosis was dilatedcardiomyopathy. Electrocardiographs were pathologic in all cases.Echocardiographic examination revealed medium to severe mitral valveregurgitation in 4 cases and reduced (< 40%) ejection fraction in 6patients. Of the 12 patients, 8 underwent direct implantation of the leftcoronary artery into the aorta, 2 underwent implantation of the rightcoronary artery into the aorta, and the remaining 2 underwent a Takeuchiprocedure. There were no early mortalities. Median hospital stay was 20 days(range, 5-35 days). Median follow-up duration was 18 months (range, 5-36months), and no cases required further surgery during follow-up.

Conclusions: Anomalous coronary arteries from the pulmonary artery can be successfullyrepaired providing there is early diagnosis and effective, appropriateintensive care unit follow-up. Therefore, coronary artery origins should beevaluated carefully, especially in cases with dilated cardiomyopathies.

No MeSH data available.


Related in: MedlinePlus

A - Apical four chamber view echocardiogram showing dilated leftventricle, hyperechogenicity in papillary muscles, ventricularseptaldefect-like appearance due to coronary collaterals andsignificant mitral regurgitation; B - Parasternal short axis viewechocardiogram showing anomalous origin of the left coronary arteryfrom pulmonary artery.
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f2: A - Apical four chamber view echocardiogram showing dilated leftventricle, hyperechogenicity in papillary muscles, ventricularseptaldefect-like appearance due to coronary collaterals andsignificant mitral regurgitation; B - Parasternal short axis viewechocardiogram showing anomalous origin of the left coronary arteryfrom pulmonary artery.

Mentions: Of the 10 patients with ALCAPA, 9 had varying degrees of LV dilatation anddysfunction. ECHO revealed varying degrees of mitral valve regurgitation (Figure 2) and collateral blood flow on theinterventricular septum in all cases, papillary muscle hyperechogenicity in 9cases, dilated right coronary artery (RCA) in 8 cases, and retrograde diastolicflow toward the pulmonary artery in 4 cases. At the initial ECHO examination,coronary arteries of 4 patients were erroneously thought to originate from theaorta.


Evaluation of Anomalous Coronary Arteries from the PulmonaryArtery
A - Apical four chamber view echocardiogram showing dilated leftventricle, hyperechogenicity in papillary muscles, ventricularseptaldefect-like appearance due to coronary collaterals andsignificant mitral regurgitation; B - Parasternal short axis viewechocardiogram showing anomalous origin of the left coronary arteryfrom pulmonary artery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5382903&req=5

f2: A - Apical four chamber view echocardiogram showing dilated leftventricle, hyperechogenicity in papillary muscles, ventricularseptaldefect-like appearance due to coronary collaterals andsignificant mitral regurgitation; B - Parasternal short axis viewechocardiogram showing anomalous origin of the left coronary arteryfrom pulmonary artery.
Mentions: Of the 10 patients with ALCAPA, 9 had varying degrees of LV dilatation anddysfunction. ECHO revealed varying degrees of mitral valve regurgitation (Figure 2) and collateral blood flow on theinterventricular septum in all cases, papillary muscle hyperechogenicity in 9cases, dilated right coronary artery (RCA) in 8 cases, and retrograde diastolicflow toward the pulmonary artery in 4 cases. At the initial ECHO examination,coronary arteries of 4 patients were erroneously thought to originate from theaorta.

View Article: PubMed Central - PubMed

ABSTRACT

Objective: This study evaluated clinical and diagnostic findings, treatment methods, andfollow-up of cases of anomalous coronary arteries from the pulmonaryartery.

Methods: The study included all cases diagnosed with anomalous coronary arteries fromthe pulmonary artery between January 2012 and January 2016. Data frompatients’ demographic characteristics, electrocardiography,echocardiography, angiographic findings, operation, intensive care unitstay, and follow-up were evaluated.

Results: The study included 12 patients (8 male, 4 female), 10 with anomalous leftcoronary artery from the pulmonary artery (ALCAPA) and 2 with anomalousright coronary artery from the pulmonary artery (ARCAPA). Median age atdiagnosis was 4 months (range, 1 month - 10 years old) and median weight was5.5 kg (range, 3-30 kg). The most common complaints were murmur (n=7) andrespiratory distress (n=5). In 4 cases, the initial diagnosis was dilatedcardiomyopathy. Electrocardiographs were pathologic in all cases.Echocardiographic examination revealed medium to severe mitral valveregurgitation in 4 cases and reduced (< 40%) ejection fraction in 6patients. Of the 12 patients, 8 underwent direct implantation of the leftcoronary artery into the aorta, 2 underwent implantation of the rightcoronary artery into the aorta, and the remaining 2 underwent a Takeuchiprocedure. There were no early mortalities. Median hospital stay was 20 days(range, 5-35 days). Median follow-up duration was 18 months (range, 5-36months), and no cases required further surgery during follow-up.

Conclusions: Anomalous coronary arteries from the pulmonary artery can be successfullyrepaired providing there is early diagnosis and effective, appropriateintensive care unit follow-up. Therefore, coronary artery origins should beevaluated carefully, especially in cases with dilated cardiomyopathies.

No MeSH data available.


Related in: MedlinePlus