2022 Volume 86 Issue 5 Pages 879-
Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital cardiovascular anomaly (also known as Bland-White-Garland syndrome). In patients with adult-type ALCAPA, cardiac surgeries to establish a dual-artery coronary system are recommended because of the risk of heart failure, lethal arrhythmia, and sudden cardiac death. However, the postoperative course of patients with adult-type ALCAPA is scarcely reported.
A 40-year-old woman with symptomatic ALCAPA was referred to hospital. Multidetector computed tomography depicted the left coronary artery (LCA) originating from the pulmonary artery with right-to-left collaterals (Figure A). Transthoracic echocardiography and cardiac magnetic resonance (CMR) imaging showed a dilated left ventricle with preserved ejection fraction (Figure B,D). We grafted the left internal mammary artery to the left anterior descending artery with closure of ostial-LCA (Figure F). At 6 months after her surgery, the coronary arteries had regressed with disappearance of the collateral vessels (Figure G). After 6 years, the tortuosity and irregularity of the LCA had largely improved (Figure H). Echocardiography and CMR showed left ventricular reverse remodeling (Figure C,E). She had been asymptomatic and free from any cardiovascular events.
Multidetector computed tomographic imaging (A) before, (F) just after, (G) 6 months after, and (H) 6 years after coronary artery bypass grafting (CABG). Echocardiographic imaging (B) before, and (C) 6 years after CABG. Cardiac magnetic resonance imaging (D) before, and (E) 6 years after CABG.
Postoperative and serial multimodal imaging demonstrated reverse remodeling of the coronary arteries and left ventricle. We have scarce knowledge about the postoperative dynamic changes of the coronary artery and left ventricle in patients with ALCAPA, and long-term follow-up with multimodal imaging could shed light on these issues.
The authors thank Shuichiro Takanashi and Yukihiro Takahashi for their insightful comments, and Tatsunori Niwa for the image processing.
The authors state that they have no conflicts of interest.
