Keywords:
Congenital, Computer Applications-Detection, diagnosis, CT, Computer applications, Cardiac
Authors:
N. Lama, V. P. Patris, M. Argiriou; Athens/GR
Results
Left main coronary artery (LM), had normal origin from the left Valsalva sinus. It was then bifurcated into a short left anterior descending artery (LAD) and the circumflex artery (CMX). A second, longer LAD with anomalous origin from the main pulmonary artery, was found coursing in the anterior interventricular groove up to the cardiac apex causing blood steal by a left-to-right shunt through the coronary system.
Anomalous Left Coronary Artery Arising from Pulmonary Artery (ALCAPA) is a rare but severe congenital cardiac anomaly and ALADAPA represent a variation of it. Patients usually present signs and symptoms of heart failure or sudden cardiac death, but there is an increasing number of reports referring to patients surviving to adulthood. Adult patients could also be asymptomatic, probably due to the broad development of coronary anastomosis (collaterals), usually to the enlarged right coronary artery (RCA), capable to perfuse the myocardium of the left ventricle (1).
During the review of the literature, no reference was found in the previous classification systems of seven types Dual LAD described, for one of two arteries to be originated from Pulmonary Artery. So we are describing what we thought it represents a new variation type.The origin of LAD is the LM, courses in the anterior interventricular groove toward the cardiac apex. Diagonal branches and septal perforator branches are arising from LAD to the anterior wall of left ventricle and intraventricular septum respectively. Rarely a Dual LAD anomaly is found.
Series of cases are describing a short LAD that terminates high in the anterior interventricular groove and a long LAD that has a proximal course outside the anterior interventricular groove and returns to the groove in its distal course(2). Non of the types listed before had the same origin as the long LAD in our case, but we also found two more similar case reports in the literature, provoking us to declare it a new type of Dual LAD.
Regarding the therapeutical approach, two different surgical treatment technics have been purposed (reimplantation of the anomalous vessel or ligation of it combined with grafting of the coronary artery), that may lead to substantial improvement of patient’s clinical symptoms (3).