PMC7508687_01
Echocardiographic and angiographic findings of the first case. A reversed flow in the LCA (A) and an abnormal flow to the MPA (B) were seen. The angiogram (C and D) showed a dilated RCA, diffuse collaterals, and the backflow in the LMCA.
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The echocardiographic checkup performed one year after her operation suggested an ALCAPA: a dilated right coronary artery (RCA), reversal flow in the left main coronary artery (LMCA) (Fig. 1A), an abnormal flow from LMCA to the main pulmonary artery (Fig. 1B), and an increased right-to-left coronary collaterals (Supplement video 1). The coronary arterial collaterals drained blood from the dilated RCA to the left circumflex (LCx) and the left anterior descending artery (LAD) and back to the MPA (Fig. 1C-D, Supplement video 2, and Supplement video 3).
Echocardiographic findings following the reimplantation of ALCAPA in the first case. The normal flow in the LMCA was reestablished (A). A mild MR (B) and a normal LV strain with mild reduction at the LMCA territory (C) were noted. Hyperechogenic chordae tendinae were seen (D).
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The coronary arterial collaterals drained blood from the dilated RCA to the left circumflex (LCx) and the left anterior descending artery (LAD) and back to the MPA (Fig. 1C-D, Supplement video 2, and Supplement video 3). The most recent echocardiography showed a good LV ejection fraction of 58%, a normal LV global longitudinal strain, a trace MR with minor hyperechogenic spots on the chordae tendineae (Fig. 2).
Echocardiographic and angiographic findings of the second case. A severe paravalvular leak was seen (A). The LAD trajectory (B) and the contrast from LAD entering the main pulmonary artery (C) showed on MSCT. The 3D reconstruction showed a dilated RCA, and diffuse collaterals (D).
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The echocardiography showed a dilated LV (LV end-diastolic diameter 64 mm), poor LV contraction (LVEF 40%), and a mitral mechanic prosthesis with profuse dehiscence causing a severe paravalvular leak (Fig. 3A), and rocking movement (Supplement video 4). To our surprise, an ALCAPA was detected: a severely dilated RCA, an anomalous LMCA from the main pulmonary artery, and increased coronary collaterals (Fig. 3B-D).
PMC7508687_02
Echocardiographic and angiographic findings of the second case. A severe paravalvular leak was seen (A). The LAD trajectory (B) and the contrast from LAD entering the main pulmonary artery (C) showed on MSCT. The 3D reconstruction showed a dilated RCA, and diffuse collaterals (D).
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The echocardiography showed a dilated LV (LV end-diastolic diameter 64 mm), poor LV contraction (LVEF 40%), and a mitral mechanic prosthesis with profuse dehiscence causing a severe paravalvular leak (Fig. 3A), and rocking movement (Supplement video 4). To our surprise, an ALCAPA was detected: a severely dilated RCA, an anomalous LMCA from the main pulmonary artery, and increased coronary collaterals (Fig. 3B-D).