Current Strategies for the Management of Anomalous Origin of Coronary Arteries from the Pulmonary Artery

Authors

  • Metin Onur Beyaz Department of Cardiovascular Surgery, Istanbul Medipol University Faculty of Medicine
  • Senay Coban Department of Pediatric Cardiology, Istanbul Medipol University Faculty of Medicine
  • Mustafa Ozer Ulukan Department of Cardiovascular Surgery, Istanbul Medipol University Faculty of Medicine
  • Mehmet Sait Dogan Department of Cardiovascular Surgery, Istanbul Medipol University Faculty of Medicine
  • Cengiz Erol Department of Cardiovascular Surgery, Istanbul Medipol University Faculty of Medicine
  • Turkay Saritas Department of Pediatric Cardiology, Istanbul Medipol University Faculty of Medicine
  • Abdullah Erdem Department of Pediatric Cardiology, Istanbul Medipol University Faculty of Medicine
  • Celal Akdeniz Department of Pediatric Cardiology, Istanbul Medipol University Faculty of Medicine
  • Murat Ugurlucan Department of Cardiovascular Surgery, Istanbul Medipol University Faculty of Medicine
  • Atif Akcevin Department of Cardiovascular Surgery, Istanbul Medipol University Faculty of Medicine
  • Halil Turkoglu Department of Cardiovascular Surgery, Istanbul Medipol University Faculty of Medicine

DOI:

https://doi.org/10.1532/hsf.3421

Keywords:

Coronary artery, Pulmonary artery, ALCAPA, ARCAPA, Congenital cardiac surgery

Abstract

Introduction: The coronary arteries, which have to originate from the aorta, may sometimes rise from the pulmonary artery. This study evaluated clinical and diagnostic findings, treatment methods, and follow up of cases with anomalous coronary arteries arising from the pulmonary artery.

Patients and methods: Eight patients with the diagnosis of anomalous left coronary artery from the pulmonary artery (ALCAPA) (N = 6) and anomalous right coronary artery from the pulmonary artery (ARCAPA) (N = 2), between January 2014 and January 2020 from a single center university hospital, were included in the study. Data from patients’ demographic characteristics, electrocardiography, echocardiography, angiographic findings, operation, hospitalization, and follow up were evaluated.

Results: The study included eight patients (six females and two males) – six patients with ALCAPA and two with ARCAPA. The ages of the patients ranged between 3-135 (average: 53.25) months. The median body weight was calculated as 17.4 kg. Severe mitral valve insufficiency was detected in two patients and two other patients had a moderate degree of mitral insufficiency on echocardiography. Ejection fractions ranged between 16-74%. One patient had perimembranous malalignment large ventricular septal defect with pulmonary stenosis. Operative techniques were Takeuchi procedure (three patients), direct implantation (four patients), and left internal thoracic artery to left main coronary artery bypass (one patient). Mechanical cardiac support was not required in the postoperative period. Mortality did not occur. Mitral insufficiency and ejection fractions improved following correction of the coronary anatomy.

Conclusion: It is important to diagnose the ALCAPA or ARCAPA, where the coronary artery originates from the pulmonary artery. Patients should be treated before congestive heart failure and fatal complications occur. Surgical correction should be planned regardless of symptom status, even though some of patients reach adulthood with an increased number of collaterals.

References

Alexi-Meskishvili V, Nasseri BA, Nordmeyer S, et al. 2011. Repair of anomalous origin of the left coronary artery from the pulmonary artery in infants and children. J Thorac Cardiovasc Surg. 142(4):868‐874.

Arnaz A, Sarioglu T, Yalcinbas Y, Erek E, Turkoz R, Oktay A, Saygili A, Altun D, Sarioglu A. 2018. Coronary artery bypass grafting in children. J Card Surg. Jan;33(1):29-34.

Ata EC, Erkanlı K, Yıldız E, Türkoğlu H. 2019. A new surgical approach to a patient with anomalous origin of left coronary artery from pulmonary artery: A case report. Turk Gogus Kalp Damar Cerrahisi Derg. Jan 1;27(1):107-110.

Balakrishna P, Illovsky M, Al-Saghir YM, Minhas AM. 2017. Anomalous Origin of Right Coronary Artery Originating from the Pulmonary Trunk (ARCAPA): an Incidental Finding in a Patient Presenting with Chest Pain. Cureus. 9(4):e1172.

Bonnemains L, Lambert V, Moulin-Zinch A, Youssef D, Serraf A. 2010. Very early correction of anomalous left coronary artery from the pulmonary artery improves intensive care management. Arch Cardiovasc Dis. 103(11):579-84.

Ceylan Ö, Örün Arman U, Koç M, Özgür S, Doğan V, Karademir S, Keskin M, Yılmaz O. 2013. Anomalous coronary artery originating from the pulmonary artery: a report of four cases. Turk Gogus Kalp Dama. 21:122-126.

Conkbayir C, Coskun U, Oztas DM, Beyaz MO, Meric M, Ugurlucan M. 2019. Coronary Arteries Arising from Single Coronary Ostium: A Case Report. Heart Surg Forum. Jun 21;22(3):E269-E270.

Conkbayir C, Oztas DM, Ugurlucan M. 2019. Right coronary artery to left carotid artery collateral in the absence of stenosis. J Card Surg. Sep;34(9):856-857.

Friedman AH, Silverman NH. 2010. Congenital anomalies of the coronary arteries. In: Anderson RH, Baker EJ, Penny D, Redington AN, Rigby ML, Wernovsky G, editors. Pediatric cardiology. 3rd ed. Philadelphia: Churchill Livingstone. p. 932-42.

Georgiev SG, Lazarov SD, Mitev ID, Latcheva AZ, Christov GA, Velkovski IG, et al. 2012. Left ventricular and mitral valve function long after repair of left anomalous coronary artery from the pulmonary artery: Recovery years after severe ischemia. World J Pediatr Congenit Heart Surg. 3:321-7.

Ghaderi F, Gholoobi A, Moeinipour A. 2014. Unique echocardiographic markers of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) in the adult. Echocardiography. 31(1):E13-5.

Guenther TM, Sherazee EA, Wisneski AD, Gustafson JD, Wozniak CJ, Raff GW. 2020. Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery: A Systematic Review. Ann Thorac Surg. S0003-4975(20)30352-0.

Gupta R, Marwah A, Shrivastva S. 2012. Anomalous origin of right coronary artery from pulmonary artery. Ann Pediatr Cardiol. 5(1):95-96.

Guzeltas A, Ozturk E, Tanidir IC, Kasar T, Haydin S. 2017. Evaluation of Anomalous Coronary Arteries from the Pulmonary Artery. Braz J Cardiovasc Surg. 32(1):29-37.

Hoashi T, Kagisaki K, Okuda N, Shiraishi I, Yagihara T, Ichikawa H. 2013. Indication of Takeuchi technique for patients with anomalous origin of the left coronary artery from the pulmonary artery. Circ J. 77:1202-7.

Jian-Yong Z, Ling H, Wen-hong D, Mei j, Gui-Zhen Z. 2010. Clinical features and long-term prognosis of patients with anomalous origin of the left coronary artery from the pulmonary artery. Chin Med J. 123(20):2888-94.

Koestenberger M, Nagel B, Gamillscheg A, Temmel W, Cvirn G, Beitzke A. 2007. Myocardial infarction in an adolescent: anomalous origin of the left main coronary artery from the right coronary sinus in association with combined prothrombotic defects. Pediatrics. 120:e424-7.

Kristensen T, Kofoed KF, Helqvist S, Helvind M, Sondergaard L. 2008. Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) presenting with ventricular fibrillation in an adult: a case report. J Cardiothorac Surg. 3(38):1-5.

Li M, Wang Y, Zhu W, Zhang C, Fei H. 2020. Transthoracic echocardiography features of adult-type anomalous left coronary artery from the pulmonary artery before and after surgery: highlights from observational study in a single center of China [published online ahead of print, 2020 Apr 23]. Int J Cardiovasc Imaging. 10.1007/s10554-020-01857-x.

Matherne GP, Lim S. 2008. Congenital anomalies of the coronary vessels and the aortic root In: Allen HD, Driscoll DJ, Shaddy RE, Feltes TF, editors. Moss and Adams’ heart disease in infants, children, and adolescents: including the fetus and young adults. 7th ed. Baltimore: Lippincott Williams & Wilkins. p. 703-25.

Naimo PS, Fricke TA, d’Udekem Y, Cochrane AD, Bullock A, Robertson T, Brizard CP, Konstantinov IE. 2016. Surgical intervention for anomalous origin of left coronary artery from the pulmonary artery in children: A long-term follow-up. Ann Thorac Surg. 101:1842-8.

Pandey NN, Sinha M, Sharma A, Rajagopal R, Bhambri K, Kumar S. 2019. Anomalies of coronary artery origin: Evaluation on multidetector CT angiography. Clin Imaging. 57:87-98.

Parasramka S, Dufresne A. 2011. Anomalous origin of right coronary artery from pulmonary artery presenting as chest pain in a young man. J Cardiol Cases. 5(1):e20-e22.

Sato Y, Sakaguchi R, Innami Y, Katori N, Morisaki H. 2013. Perioperative management of a patient with anomalous origin of the left coronary artery from the pulmonary artery. Masui. 62(10):1191-3.

Su JT, Krishnamurthy R, Chung T, Vick GW 3rd, Kovalchin JP. 2007. Anomalous right coronary artery from the pulmonary artery: noninvasive diagnosis and serial evaluation. J Cardiovasc Magn Reson. 9(1):57-61.

Tsutsumi K. 2014. Surgical repair of anomalous connection of the left coronary artery. SAGE Open Med Case Rep. 2: 2050313X14550118.

Ugurlucan M, Yildiz Y, Ulukan MO, Oztas DM, Beyaz MO, Canata E, Coban S, Unal O, Erkanli K, Turkoglu H. 2020. A surgical technique for ascending aorta, aortic arch and descending aorta replacement without cross-clamp, circulatory arrest or hypothermia. Cardiol Young. Jan;30(1):24-27.

Williams IA, Gersony WM, Hellenbrand WE. 2006. Anomalous right coronary artery arising from the pulmonary artery: a report of 7 cases and a review of the literature. Am Heart J. 152(5):1004.e9‐1004.e1.004E17.

Yakut K, Tokel NK, Ozkan M, Varan B, Erdogan I, Aslamaci MS. 2019. Diagnosis and treatment of abnormal left coronary artery originating from the pulmonary artery: A single center experience. Anatol J Cardiol. 22(6):325-331.

Zheng JY, Han L, Ding WH, Jin M, Zhang GZ, Xiao YY, Luo Y, Cheng P, Meng X, Zhao QM. 2010. Clinical features and long-term prognosis of patients with anomalous origin of the left coronary artery from the pulmonary artery. Chin Med J (Engl). 123(20):2888–2894.

Published

2021-01-20

How to Cite

Beyaz, M. O., COBAN , S. ., ULUKAN, M. O. ., DOGAN , M. S. ., EROL , C. ., SARITAS , T. ., ERDEM , A., AKDENIZ, C. . ., UGURLUCAN , M. ., AKCEVIN , A. ., & TURKOGLU , H. . (2021). Current Strategies for the Management of Anomalous Origin of Coronary Arteries from the Pulmonary Artery. The Heart Surgery Forum, 24(1), E065-E071. https://doi.org/10.1532/hsf.3421

Issue

Vol. 24 No. 1 (2021)

Section

Articles

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