Coronary-to-pulmonary artery collaterals in pulmonary atresi
Pulmonary blood flow in cases of pulmonary atresia may be provided by the ductus arteriosus or by aorto-pulmonary collaterals. Collateral arteries may arise from coronary arteries and rarely they may be the sole source of pulmonary blood flow. Published in the journal Annals of Pediatric Cardiology. The authors describe a case of a 2-month-old baby with pulmonary atresia whose pulmonary blood flow was solely dependent on collaterals form coronary arteries.

A 2-month-old baby was referred with a diagnosis of large subaortic ventricular septal defect (VSD) with valvar pulmonary atresia. Detailed echocardiogram revealed that the origin of the left coronary artery (LCA) and right coronary artery (RCA) was dilated.

The proximal LCA was supplying a large collateral to the pulmonary artery and subsequently dividing into left anterior descending artery and left circumflex artery. A large collateral artery from the proximal RCA was coursing anterior to the aorta and was supplying the pulmonary artery near the pulmonary valve.

Pulse Doppler of the collateral flow demonstrated that predominant flow into the pulmonary artery occurred during systole. Cardiac computed tomography confirmed the coronary collaterals to the pulmonary artery and showed that there were no other aortopulmonary collaterals, making this a coronary dependent pulmonary circulation.

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