J Cardiovasc Ultrasound.  2012 Dec;20(4):197-200. 10.4250/jcu.2012.20.4.197.

Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery Initially Visualized by Echocardiography and Multidetector Computed Tomography Coronary Angiography

• Kim BH
• Park YW
• Hong SP
• Son JY
• Lee YS
• Lee JB
• Ryu JK
• Choi JY
• Kim KS
• Chang SG

• KMID: 2177408
• DOI: http://doi.org/10.4250/jcu.2012.20.4.197

Abstract

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly associated with very high mortality during infancy. We report a 35-year-old female patient with ALCAPA initially visualized by echocardiography. She visited outpatient department presenting with intermittent chest discomfort for 3 weeks. Transthoracic echocardiography showed left coronary artery arising from main pulmonary artery and abundant septal color flow Doppler signals. Transesophageal echocardiography clearly revealed markedly dilated and tortuous right coronary artery showing windsock appearance. Multidetector computed tomography and coronary angiography enabled visualization of anomalous left coronary artery originating from left side of main pulmonary trunk. After treadmill exercise test which showed ST-segment depression presenting inducible myocardial ischemia, patient underwent direct re-implantation of the anomalous coronary artery into the aorta without any complication.

Keyword

Coronary vessel anomalies; Echocardiography; Computed tomography

MeSH Terms

Aorta
Coronary Angiography
Coronary Vessel Anomalies
Coronary Vessels
Depression
Echocardiography
Echocardiography, Transesophageal
Exercise Test
Female
Humans
Multidetector Computed Tomography
Myocardial Ischemia
Outpatients
Pulmonary Artery
Thorax

Figure

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  Fig. 1 Transthoracic echocardiography showed LCA arising from main PA (A) and abundant septal color flow signals in apical four chamber view (B) and pulse wave Doppler signals in parasternal short axis view (C). Transesophageal echocardiography revealed markedly dilated and tortuous RCA showing windsock appearance (D). AO: aorta, PA: pulmonary artery, PV: pulmonic valve, LCA OS: left coronary artery ostium, RA: right atrium, LA: left atrium, RCA: right coronary artery.

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  Fig. 2 A: Three dimensional volume rendering image of multidetector computed tomography coronary angiography showed LCA beginning from left side of the PA. B: In coronary angiography, right coronary artery was extraordinarily dilated and tortuous with abundant collateral channels (arrow) draining into PA through LCA. LCA: left coronary artery, PA: pulmonary artery.

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  Fig. 3 Treadmill exercise test (A: resting, B: during exercise) showed ST-segment depression in lead II, III, aVF and V6 (arrows) presenting inducible myocardial ischemia.

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  Fig. 4 Intraoperative photographs showing dilated and tortuous RCA (A) and direct re-implantation of the anomalous LCA into the aorta (B). RCA: right coronary artery, RA: right atrium, AO: aorta, LCA: left coronary artery.

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