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Case Reports
. 2024 Jan 5;24(1):31.
doi: 10.1186/s12872-023-03686-x.

Adult-type anomalous origin of the left coronary artery from the pulmonary artery and right coronary-right atrial fistula: a case report

Hao Luo  1 , Ofe Eugene Kwaku  1 , Yinglong Lai  2 , Rongchuan Yue  3   4
Affiliations
Case Reports

Adult-type anomalous origin of the left coronary artery from the pulmonary artery and right coronary-right atrial fistula: a case report

Hao Luo et al. BMC Cardiovasc Disord. .

Abstract

Background: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital cardiac anomaly, mortality rates in infancy reach approximately 90%, with only a small number of patients surviving into adulthood, therefore, most of the literature reports mainly focus on infantile type.

Case presentation: A 55-year-old female was admitted due to persistent repeated chest pain experienced and had worsened for unknown reasons. Color doppler echocardiography, coronary computed tomographic angiography, and coronary angiography confirmed the diagnosis of ALCAPA and concurrent right coronary artery-right atrial fistula. The symptoms of chest pain exhibited notable improvement subsequent to corrective surgery for the anomalous origin of the coronary artery.

Conclusions: This report shows an unique case of ALCAPA in an adult patient, characterizing the condition's combination with a right coronary-right atrial fistula, and it is prone to misdiagnosis and misdiagnosis. We aim to provide valuable insights for clinical diagnosis and treatment of ALCAPA.

Keywords: ALCAPA; Congenital heart disease; Coronary artery fistula; Surgical intervention.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Preoperative color Doppler echocardiography. A The left coronary artery (yellow arrow) visible in the left posterior lateral wall of the middle part of the pulmonary artery. B Dilation of the right coronary artery (yellow arrow) originating from the right aortic sinus; C: Star point blood flow signal can be seen in the myocardium of ventricular septum and lateral wall of left ventricle, PW detection and diastolic phase are the main blood flow signal. AO: aorta, LA: left atrium, LCA: left coronary artery, RCA: right coronary artery
Fig. 2
Fig. 2
Preoperative coronary computed tomographic angiography. A The ectopic left coronary artery originated from the pulmonary artery. B The right coronary artery originates from the right aortic sinus. AO: aorta, PA: pulmonary artery, LA: left atrium, LAD: left anterior descending branch, LCX: left circumflex branch, RCA: right coronary artery
Fig. 3
Fig. 3
Postoperative color doppler echocardiography. A A 7 mm wide tubular echoless area - artificial blood vessel (yellow arrow) could be seen at about 4 o ‘clock on the short axis section of the great artery. B Color blood flow Doppler imaging indicated that star point blood flow signals could be seen in the myocardium of ventricular septum and left ventricular wall. AO: aorta, LA: left atrium, RVOT: right ventricular outflow tract, Artificial blood vessel: artificial blood vessel
Fig. 4
Fig. 4
Postoperative coronary computed tomographic angiography. A-D The 6 mm GORE-TEX artificial vessel was connected to the left coronary artery and the aortic root for coronary branch dilation, and the coronary artery presented a right dominant type. AO: aorta, PA: pulmonary artery, LAD: left anterior descending branch, LCX: left circumflex branch, RCA: right coronary artery, Artificial blood vessel: artificial blood vessel
See this image and copyright information in PMC

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