CASE REPORT   

Journal of Radiological Review 2021 March;8(1):9-11

DOI: 10.23736/S2723-9284.20.00085-5

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Anomalous origin of the left coronary artery from the pulmonary artery syndrome in a young adult

Giovanni RISOLEO ✉, Silvia INNAMORATI, Claudia DE BERARDINIS, Carmine ANDRIULO ⁴, Noemi PERILLO, Elisa D’ASCOLI, Angelo VANZULLI

Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, University La Statale, Milan, Italy

The anomalous origin of the left coronary artery from the pulmonary artery syndrome, or ALCAPA syndrome, is a rare congenital disease leading to death in 90% of children during their first year of life, due to myocardial infarction and congestive heart failure. Rarely, ALCAPA syndrome can manifest in adults because of the development of collateral circles that maintain an adequate blood flow between the right coronary artery (RCA) and the left coronary artery (LCA). Some of these patients may be asymptomatic; however, if the collateral vessels are not efficient in supplying blood to the left ventricle, it may lead to chronic left ventricular subendocardial ischemia, malignant ventricular dysrhythmias and sudden cardiac death. Therefore, awareness of this condition is essential for prompt diagnosis and treatment. Here we present the case of a 23-year-old asymptomatic male with familiarity for cardiovascular diseases, who was diagnosed with left bundle branch block, left ventricular hypertrophy and low R progression in V1-V3 on ECG. Echocardiography demonstrated decreased global systolic function, while MRI documented subendocardial delayed enhancement of the septum and the anterior wall, findings suspicious for left anterior descending (LAD) artery disease. The patient underwent a coronarography, which documented contrast medium flow from the left coronary artery to the main pulmonary artery; anomalous origin of LCA from the main pulmonary trunk was finally visualized trough coronary CT angiography (CCTA). Direct reimplantation of the anomalous artery into the aorta and reconstruction of the main pulmonary trunk with a tubular Dacron prosthesis were performed; postoperative recovery was uneventful.

KEY WORDS: Anomalous left coronary artery; Pulmonary artery; Electrocardiography; Computed tomography angiography