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Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery in Children: 15 Years Experience

Pediatric Cardiology volume 32, pages 24–31 (2011)Cite this article

Abstract

This study aimed to illustrate the experience of treating children with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). The clinical data for 19 children with ALCAPA admitted to Beijing Anzhen Hospital from August 1993 to June 2009 were reviewed. According to the data, 47.4% (9/19) of the patients had a misdiagnosis of endocardial fibroelastosis, and 15.8% (3/19) had a misdisgnosis of dilated cardiomyopathy. Electrocardiography showed abnormal Q waves with T wave inversion in leads I, avL, and V4-V6 of 18 patients, especially in lead avL. The ratio of proximal right coronary artery diameter to aotic root diameter exceeded 0.20 for 15 of 16 patients. Apical ventricular aneurysm or aneurysmal dilation (52.6%,10/19), enhanced echogenicity of papillary muscles (84.2%, 16/19), and increased coronary collaterals (78.9%, 15/19) were detected frequently during echocardiography. A total of 18 patients underwent cardiac surgery including left coronary artery (LCA) ligation for 1 patient (5.6%), LCA ligation plus coronary artery bypass grafting for 1 patient (5.6%), Takeuchi operation for 7 patients (38.9%), and LCA reimplantation for 9 patients (50.0%). Five patients died in the hospital, and the remainder were asymptomatic during a follow-up period of 6 to 166 months. Their abnormal Q waves gradually regressed, and left ventricular systolic function and size returned to normal with alleviation of mitral insufficiency. The clinical features of ALCAPA are helpful for determining an accurate diagnosis. This anomaly can be treated successfully by several types of operations with good prognosis.

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Affiliations

  1. Department of Pediatric Cardiology and Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Beijing, 100029, People’s Republic of China

    Jianyong Zheng, Wenhong Ding, Yanyan Xiao, Mei Jin, Guizhen Zhang, Pei Cheng & Ling Han

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  1. Jianyong Zheng
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  2. Wenhong Ding
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  4. Mei Jin
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  5. Guizhen Zhang
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  6. Pei Cheng
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  7. Ling Han
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Correspondence to Ling Han.

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Zheng, J., Ding, W., Xiao, Y. et al. Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery in Children: 15 Years Experience. Pediatr Cardiol 32, 24–31 (2011). https://doi.org/10.1007/s00246-010-9798-2

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  • DOI: https://doi.org/10.1007/s00246-010-9798-2

Keywords

  • Cardiac surgical procedures
  • Coronary artery disease
  • Echocardiography
  • Electrocardiography
  • Pulmonary artery