Anomalous origin of coronary arteries from pulmonary artery
Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...
Get authentic, real-time news that helps you fight COVID-19 better.
Install PlexusMD App for doctors. It's free.
An anomalous origin of the left coronary artery from the pulmonary artery accounts for 0.25–0.5% of diagnosed congenital heart disease, whilst an anomalous origin of the right coronary artery from the pulmonary artery is rare still accounting for only 0.002%.

Clinical presentation is variable and can include an incidental finding of a murmur, angina, silent ischaemia, left ventricular dysfunction, or congestive heart failure.

In all cases of anomalous origin of coronary arteries from pulmonary artery, surgical correction is recommended to avoid a progressive of ischaemia, arrhythmias, or sudden death.

A 73-year-old male patient with no past history of myocardial infarction, presented with dyspnoea and orthopnoea. He did not report any chest pain. On examination, a systolic murmur was audible over the mitral valve area and a diastolic murmur over aortic valve area. Electrocardiogram (ECG) demonstrated a left bundle branch block. Transthoracic echocardiogram (TTE) showed a dilated left ventricle (LV) with global hypokinesis and a left ventricular ejection fraction (LVEF) of 17%.

In addition, he had severe mitral regurgitation, moderate to severe aortic regurgitation, and pulmonary systolic artery pressure (PSAP) 67 mmHg (normal reference values for PSAP < 36 mmHg). Coronary angiography revealed an ectatic left anterior descending artery (LAD), which provided collaterals to the right coronary artery (RCA). Retrograde filling of RCA was evident with drainage into the pulmonary artery (PA). A diagnosis of ARCAPA was then made and surgical correction was offered which the patient refused. Medical therapy with betablockers, angiotensin-converting enzyme inhibitors (ACEIs), and diuretic therapy was initiated. The patient did not receive device-based therapy. The patient died 7 years of post-diagnosis.

Source: https://academic.oup.com/ehjcr/advance-article/doi/10.1093/ehjcr/ytaa047/5803788
Like
Comment
Share