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      Anomalous Left Anterior Descending Coronary Artery Arising from Pulmonary Artery in a 63 Year-old Male Patient: Case Report and Literature Review

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          Abstract

          To present a case of a rare congenital coronary anomaly in an adult patient, which was not reported before in Palestine, review the literature, and compare with previously reported cases.

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          Coronary artery anomalies in 126,595 patients undergoing coronary arteriography.

          O Yamanaka, R. E. Hobbs (1990)
          Coronary artery anomalies were found in 1,686 patients (1.3% incidence) undergoing coronary arteriography at the Cleveland Clinic Foundation from 1960 to 1988. Of the 1,686 patients, 1,461 (87%) had anomalies of origin and distribution, and 225 (13%) had coronary artery fistulae. Most coronary anomalies did not result in signs, symptoms, or complications, and usually were discovered as incidental findings at the time of catheterization. Eighty-one percent were "benign" anomalies: 1) separate origin of the left anterior descending and circumflex from the left sinus of Valsalva; 2) ectopic origin of the circumflex from the right sinus of Valsalva; 3) ectopic coronary origin from the posterior sinus of Valsalva; 4) anomalous coronary origin from the ascending aorta; 5) absent circumflex; 6) intercoronary communications; and 7) small coronary artery fistulae. Other anomalies may be associated with potentially serious sequelae such as angina pectoris, myocardial infarction, syncope, cardiac arrhythmias, congestive heart failure, or sudden death. Potentially serious anomalies include: 1) ectopic coronary origin from the pulmonary artery; 2) ectopic coronary origin from the opposite aortic sinus; 3) single coronary artery; and 4) large coronary fistulae. Coronary artery anomalies require accurate recognition, and at times, surgical correction.
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            Anomalous origin of coronary arteries and risk of sudden death: a study based on an autopsy population of congenital heart disease.

            C Frescura, L Daliento, G Thiene … (1998)
            Coronary arteries anomalies may be part of complex congenital malformations of the heart or be an isolated defect. In our anatomic collection of congenital heart disease, an isolated anomalous origin of coronary arteries was observed in 27 of 1,200 specimens (2.2%): left coronary artery from pulmonary trunk in five, origin from the wrong aortic sinus in 12 (both right and left coronary artery from the right sinus in four and from the left sinus in seven, left coronary artery from the posterior sinus in one), left circumflex branch from right aortic sinus or from very proximal right coronary artery in three, high takeoff of right coronary artery in three, stenosis of the coronary ostia attributable to valvelike ridge in four. In 16 (59%) patients (12 males and 4 females, age ranging from 2 months to 53 years; median, 14), the final outcome was sudden death; it occurred in all cases of left coronary artery origin from right aortic sinus, in 43% of right coronary artery origin from left aortic sinus, and in 40% of the left coronary artery from the pulmonary trunk. Sudden death was precipitated by effort in eight (50%) and was the first manifestation of the disease in eight (50%); previous symptoms consisted of recurrent syncope in four, palpitations in three, and chest pain in one. Five patients who died suddenly during effort were athletes. In conclusion, (1) more than half of our postmortem cases with anomalous origin of coronary arteries died suddenly, (2) all but two patients with sudden death had anomalous coronary artery origin from the aorta itself, (3) the fatal event was frequently precipitated by effort, (4) palpitations, syncope, and ventricular arrhythmias were the only prodromic symptoms and signs. Recognition during life of these coronary anomalies, by the use of noninvasive procedures, is mandatory to prevent the risk of sudden death and to plan surgical correction if clinically indicated.
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              Congenital anomalies of the coronary arteries.

              Michael Hauser (2005)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Heart Views
                Journal ID (iso-abbrev): Heart Views
                Journal ID (publisher-id): HV
                Title: Heart Views : The Official Journal of the Gulf Heart Association
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 1995-705X
                ISSN (Electronic): 0976-5123
                Publication date (Print): Jul-Sep 2015
                Volume: 16
                Issue: 3
                Pages: 98-103
                Affiliations
                [1 ]Department of Cardiology and Cardiac Cath, European Gaza Hospital, Gaza, Palestine
                [2 ]Department of Cardiac Surgery, European Gaza Hospital, Gaza, Palestine
                [3 ]Department of Radiology, European Gaza Hospital, Gaza, Palestine
                Author notes
                Address for correspondence: Dr. Montasser Y. Ismail, Department of Cardiology and Cardiac Cath, European Gaza Hospital, Assistant Professor of Cardiology, Islamic University – Gaza, PO Box: 5375, Gaza - Palestine. E-mail: mont_pal@ 123456yahoo.com
                Article
                Publisher ID: HV-16-98
                DOI: 10.4103/1995-705X.164461
                PMC ID: 4590193
                SO-VID: 2e72c4d0-1ce2-4f3a-993c-2efa4a073dbe
                Copyright © Copyright: © Gulf Heart Association 2015.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

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                Categories
                Subject: Case Report

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: alcapa,anomalous left coronary artery arising from pulmonary artery,anomalous left anterior descending artery arising from pulmonary artery,congenital coronary anomaly,lad from pa
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: alcapa, anomalous left coronary artery arising from pulmonary artery, anomalous left anterior descending artery arising from pulmonary artery, congenital coronary anomaly, lad from pa

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