PMC5832159_01
(a) The left coronary artery (LCA) originating from the pulmonary artery. (b) Reversal of blood flow in the left coronary artery (LCA) and abundant collateral circulation. (c) The abundant collateral circulation. (d) Severe mitral regurgitation (MR).
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Echocardiography demonstrated ALCAPA, right coronary artery to right ventriclar fistula, right coronary artery aneurysm, collateral coronary circulation formation, severe mitral regurgitation (MR), left ventricular ejection fraction (LVEF) of 61%, and left ventricular fractional shortening (LVFS) of 33% (Figure 1).
(a) Left ventricle angiography visualizing both right coronary artery (RCA) and delayed filling of the left coronary artery (LCA). (b) The aortic root angiography; only right coronary artery (RCA) originating from the right coronary cusp was imaged immediately. (c) Pulmonary arterial angiography; the left coronary artery (LCA) was imaged immediately, originating from the pulmonary artery; the RCA was then imaged via abundant collateral circulation.
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Finally, PA angiography showed immediate filling of the LCA, which originated from the PA; then abundant collateral circulation and delayed RCA were imaged (Figure 2), confirming the diagnosis of ALCAPA.
The image in the surgery shows the left coronary artery originating from the pulmonary artery. The diagram displays the right coronary artery (RCA) originating from the aorta artery (AO) while the left coronary artery (LCA) from the pulmonary artery originating from the pulmonary artery (PA).
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PA trunk, a dilated and tortuous RCA from the RCC, extensive intercoronary collaterals, and anterior mitral valve prolapse were confirmed (Figure 3). Postoperative bedside echocardiography showed LCA connected to aorta sinus, bilateral coronary artery aneurysms (Figure 4), and moderate-to-severe MR with LVEF of 71%, LVFS of 39%.
(a, b) The dilated left coronary artery connected to the aorta in the two-dimensional and color doppler flow imaging(CDFI). (c) The dilated right coronary artery connected to the aorta. (d) Moderate-to-severe mitral regurgitation.
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PA trunk, a dilated and tortuous RCA from the RCC, extensive intercoronary collaterals, and anterior mitral valve prolapse were confirmed (Figure 3). Postoperative bedside echocardiography showed LCA connected to aorta sinus, bilateral coronary artery aneurysms (Figure 4), and moderate-to-severe MR with LVEF of 71%, LVFS of 39%.
(a, b, c) Bilateral coronary artery aneurysms and moderate mitral regurgitation on the first month after the surgery. (d, e, f) The right coronary artery aneurysms/dilated left coronary artery and mild-to-moderate mitral regurgitation on the sixth month after the surgery. (g, h, i) Bilateral dilated coronary arteries and mild mitral regurgitation on the first year after the surgery.
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We followed the patient on the first month (bilateral coronary artery aneurysms and moderate MR with LVEF of 61%, LVFS of 32%), sixth month (right coronary artery aneurysms/dilated left coronary artery and mild-to-moderate MR with LVEF of 65%, LVFS of 35%), and first year (bilateral dilated coronary arteries and mild MR with LVEF of 67%, LVFS of 34%) after the surgery by echocardiography (Figure 5), and the patient showed good functional recovery.