Bland–White–Garland syndrome

Excerpt

A 29-year-old woman experienced syncope due to ventricular fibrillation and recovered following automated external defibrillation. She was transferred to the National Cerebral and Cardiovascular Center to determine the cause of the ventricular fibrillation. On 2-dimensional echocardiography, the left ventricle was mildly dilated (diastolic diameter, 57 mm), and the inferior wall showed mild hypokinesis with ejection fraction of 55%. The orifice of the right coronary artery was dilated (diameter, 7.6 mm). Color Doppler echocardiography of the left ventricular short-axis image showed upward flow in the ventricular septum, suggesting reversed flow in the dilated septal coronary artery. Other flow seen in the posterior and lateral walls was compatible with the left circumflex coronary artery flowing in a reverse fashion. This reversed flow was confirmed in the 4-chamber view. In the apical 2-chamber view, the flow signal in the right coronary artery was upward and marked. These retrograde flows seemed to drain into the pulmonary artery. Thus, this patient was diagnosed as having anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), so-called Bland–White–Garland syndrome [1]. The diagnosis was confirmed by computed tomography and coronary angiography. She underwent successful translocation of the left coronary artery and reconstruction of the pulmonary artery. …