Case reportsEmergency ligation of anomalous left coronary artery arising from the pulmonary artery
Section snippets
Patient 1
In June 1979, a 5-month-old girl was admitted because of severe congestive heart failure with dilated cardiomyopathy. The diagnosis of ALCAPA was suspected with the electrocardiographic (ECG) changes and confirmed by cardiac catheterization in which large intercoronary vessels were visualized and left-to-right shunt was detected. One day after admission, the baby experienced worsening cardiac failure, severe low output state despite inotropic support, and arrested heart. In that scenario,
Comment
The pleural cavity was entered through a posterolateral thoracotomy. The lung was retracted and the pericardium was opened in a longitudinal fashion. The anomalous left coronary artery was identified and doubly ligated proximal to its origin. The chest was closed in the usual fashion.
In patient 1, after retracting the lung, the heart arrested and internal cardiac massage was instituted. The coronary artery was ligated in an arrested heart. Both patients markedly improved left ventricular
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Cited by (32)
Management of anomalous origin of the left coronary artery from the pulmonary artery in an adult with ischemic cardiomyopathy and pulmonary hypertension
2014, Annals of Thoracic SurgeryCitation Excerpt :Adult patients with ALCAPA are at risk for sudden death. Surgical ligation of the LMCA has been offered to such patients [5]. More recently, transcatheter embolization of the LMCA has been reported in a patient felt to be unsuitable for surgical reimplantation of the LMCA [6].
Successful percutaneous treatment of anomalous left coronary artery from pulmonary artery
2007, International Journal of CardiologyCitation Excerpt :Those patients with satisfactory collateralization may have a variable onset of symptoms. Large interconnections, as in our patient, can be associated with myocardial steal and consequent myocardial ischemia from left to right shunting and develop left ventricular dysfunction [3,5]. These patients also are at risk of sudden cardiac death [2,6].
Anomalous origin of the left coronary artery from the right pulmonary artery complicating a case of coarctation of the aorta
2004, Journal of Cardiothoracic and Vascular AnesthesiaAnomalous coronary artery origin from the pulmonary artery: Correlation between surgical timing and left ventricular function recovery
2003, Annals of Thoracic SurgeryCitation Excerpt :Currently, simple ligation of the anomalous coronary artery is not recommended because of the risk of sudden death associated with a single coronary artery system and reduced myocardial flow reserve, as demonstrated by impaired treadmill exercise tolerance. However, emergency ligation of the anomalous coronary artery in infancy has been recently reported as a lifesaving procedure for patients with compromised cardiac output presenting in centers where circulatory assist devices are not available [14]. The general consensus towards restitution of a dual coronary circulation is supported by the superb results of early and late survival, associated with apparently complete recovery of LV function at late follow-up [9].