Anomalous Left Coronary Artery

An anomalous left coronary artery arises from the pulmonary artery instead of the aorta(aka ALCAPA, ALCAPA syndrome, and Bland-White-Garland syndrome).

Anomalous left coronary artery (ALCAPA) is a congenital heart defect in which the left coronary artery originates from the pulmonary artery instead of the aorta.

Contents

Signs and Symptoms

Symptoms

  • Crying or sweating during feeding
  • Pale skin
  • Poor feeding
  • Rapid breathing
  • Sweating
  • Symptoms of pain or distress in the baby (often mistaken for colic)

Signs

  • Abnormal heart rhythm
  • Enlarged heart
  • Heart murmur (rare)
  • Rapid pulse

Diagnosis

  • EKG
  • Echocardiography
  • Arteriography
  • Cardiac Catheterization
  • MRI
  • Cardiac CT


CT Findings in this patient

There is anomalous left main coronary artery that courses between the RVOT and the left ventricular septum.

Along the course of the left main, there are septal branches where the vessel is completely surrounded by left ventricle and the RVOT.


There is also a short segment bridge of the RCA, distal to the high grade lesion reported.


LEFT MAIN:

The left main coronary artery is a large long vessel that has an anomalous origin arising from the right coronary cusp.

The LMT is patent and without angiographic stenosis.

The course of the left coronary artery passes along the RV outflow tract, not intra-arterial.


LEFT ANTERIOR DESCENDING (LAD):

The LAD is a large vessel arising after a septal perforator.

The LAD gives rise to two small diagonals which are nonevaluable.

The proximal and mid LAD is patent and without angiographic stenosis.

The distal LAD is small and poorly seen but appears patent.


LEFT CIRCUMFLEX (LCX):

The LCx is a small non-dominant vessel that gives rise to 3 OMs.

The proximal and mid segments of the LCX shows 3 focal calcified plaques with an associated stenosis of less than 20% .

OM1 demonstrates no angiographic stenosis. OM2 is nonevaluable.

OM3 has a soft plaque in its proximal segment with mild <50%) narrowing.

The distal segment of the LCX is nonevaluable.


RIGHT CORONARY ARTERY (RCA):

The RCA is a a large dominant vessel that gives rise to two acute marginals , the PDA and a PVL.

The proximal RCA has a mixed calcified plaque with a focal stenosis of greater than 70%.

The mid RCA has a moderate lesion, mixed plaque of 50% stenosis.

The distal segment of the RCA shows a small segment of plaque with an associated stenosis of 20%.

The mid segment of the RCA, RPDA and RPVL are patent and without angiographic stenosis.


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