Anomalous origin of coronary arteries from pulmonary artery in adults: a case series

Abstract

Background: Anomalous origin of a coronary artery from the pulmonary trunk is a small group of rare congenital anomalies present in up to 1% of the population. These patients, in absence of an adequate collateral supply, may present with congestive heart failure secondary to ischaemia, arrhythmia, or sudden cardiac death in up to 90% of cases within the first months of life.

Case summary: We present four cases diagnosed in adulthood over 10 years in two high-volume centres. The first patient presented with dyspnoea and orthopnoea. The second with chest pain and episodes of non-sustained ventricular tachycardia. The third patient presented during her third pregnancy with chest pain, palpitations, and arrhythmia (non-sustained ventricular tachycardia). The fourth patient presented with sudden cardiac death.

Discussion: In all cases with anomalous origin of coronary arteries, it is recommendable to consider surgical correction to avoid the progression of ischaemia, congestive heart failure, arrhythmia, and sudden death.

Keywords: ALCAPA; ARCAPA; Anomalous origin of coronary artery; Case report; Case series.

Figure 1

Anomalous origin of the right coronary artery from pulmonary artery. Coronary angiography in anteroposterior view displaying an ectatic left coronary artery which gives collateral circulation to an ectatic right coronary artery with final drainage into the pulmonary artery.

Figure 2

Anomalous origin of left coronary artery from pulmonary artery. Coronary angiography in left anterior oblique view which shows an ectatic right coronary artery, with normal filling with left circumflex artery and left anterior descending artery collaterals. The drainage of left coronary artery into the pulmonary artery is depicted.

Figure 3

Anomalous origin of left coronary artery from pulmonary artery. (A) Coronary computed tomography angiography (CCTA) displaying the origin of the left main from the pulmonary artery trunk. (B) Three-dimensional reconstruction of CCTA displaying the origin of the right coronary artery from the aortic root and the origin of the left main stem from the pulmonary artery trunk.

Figure 4

(A and B) Volume rendering images showing arterial bypass graft patency: right internal thoracic artery to left anterior descending artery (*) and left internal thoracic artery to obtuse marginal artery (+). Persistent dilation of the native coronary vessel tree.