Left main coronary artery compression by the right pulmonary artery in a patient with congenital pulmonic stenosis

The frequency of coronary artery fistula among all coronary angiography patients is 0.1% to 0.2%; however, involvement of both the pulmonary artery and the right ventricle is a rare clinical entity. A 53-year-old man patient was admitted to our clinic with rarely occurring chest pain, palpitations, and dyspnea. A coronary angiogram showed a fistula between the left main coronary artery and both the pulmonary artery and the right ventricle. We performed a ligation of this fistula without cardiopulmonary bypass. Aorta and right ventricle sutures were made, and the proximal and distal portions of the fistula were obliterated with 5-0 Prolene sutures and previously prepared Teflon felt. The patient recovered and was discharged without any complications. The surgical indications for coronary artery fistulas are symptomatic disease, an aneurysmic coronary artery, signs of heart failure, and ischemia. The surgical options in such cases�depending on whether the fistula is complicated or not�are simple ligation or transarterial ligation under cardiopulmonary bypass.

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Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709616684629 ◽

2017 ◽

Vol 5 (1) ◽

pp. 232470961668462 ◽

Cited By ~ 1

Author(s):

Venkat Gangadharan ◽

Kamesh Sivagnanam ◽

Ghulam Murtaza ◽

Michael Ponders ◽

Otto Teixeira ◽

...

Keyword(s):

Coronary Artery ◽

Pulmonary Artery ◽

Left Main Coronary Artery ◽

Main Pulmonary Artery ◽

Shortness Of Breath ◽

Left Heart ◽

Coronary Angiogram ◽

Left Main ◽

Large Area ◽

The Right

A 36-year-old woman was seen with complaints of exertional chest pain and shortness of breath. Her medical history included atrial fibrillation and diabetes. Physical examination was unremarkable except for an irregular cardiac rhythm. Myocardial perfusion imaging revealed the presence of a large area of infarction involving the entire anterior and apical walls and part of the anteroseptal wall with minimal periinfarct ischemia. Computed tomography coronary angiogram revealed an anomalous left main coronary artery arising from the main pulmonary artery. Right and left heart catheterizations demonstrated moderate pulmonary hypertension with a slight step-up in oxygen saturation between the right ventricle and main pulmonary artery. Coronary angiography showed a large tortuous right coronary artery with collaterals to the left anterior descending artery that drained into the main pulmonary artery. She was referred for surgery. This case demonstrates a rare coronary artery anomaly in an adult where survival is dependent on collateral circulation.

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ANOMALOUS AORTIC ORIGIN OF THE LEFT MAIN CORONARY ARTERY ASSOCIATED WITH ARTERIAL COMPRESSION - CASE REPORT

10.22541/au.160927527.79031349/v1 ◽

2020 ◽

Author(s):

Davi Tenório ◽

Leonardo Miana ◽

Antonio Carlos de Almeida Barbosa Filho ◽

Monica Gonzales Coronel ◽

Gustavo Guerreiro ◽

...

Keyword(s):

Coronary Artery ◽

Pulmonary Artery ◽

Left Coronary Artery ◽

Left Main Coronary Artery ◽

Postoperative Recovery ◽

Shortness Of Breath ◽

Left Main ◽

External Compression ◽

The Right

Anomalous Aortic Origin of Coronary Artery (AAOCA) is a rare finding, with varied presentation and symptomatology. Increasingly recognized by cardiac imaging, when found it raises questions about the appropriate approach and management. We present a case of an 11-year-old female who presented with episodes of shortness of breath, angina and syncope during exercise. Further investigation demonstrated episodes of nonsustained ventricular tachycardia on Holter and coronary angiotomography revealed that the left coronary artery had an anomalous origin from the right cusp with initial short intramural segment and significant external compression in its initial course between the aorta and the pulmonary artery. Patient was submitted to surgical correction with dissection of left coronary artery posterior to the pulmonary artery, coronary arteriotomy, roof ampliation with autologous pericardium and creation of neo-ostium in aorta. Patient had satisfactory postoperative recovery, was discharged on the fifth day post op, and remains asymptomatic after six months follow-up. Herein we present surgical video and postoperative echo and CT scan.

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Incidentally Diagnosed Malignant Coronary Artery Anomaly: A Clinical Case

Medicina ◽

10.3390/medicina49100072 ◽

2013 ◽

Vol 49 (10) ◽

pp. 72

Author(s):

Domas Golubickas ◽

Justina Motiejūnaitė ◽

Antanas Jankauskas ◽

Rimvydas Šlapikas ◽

Algidas Basevičius

Keyword(s):

Coronary Artery ◽

Pulmonary Artery ◽

Left Main Coronary Artery ◽

Coronary Artery Anomalies ◽

Heavy Exercise ◽

Left Main ◽

Investigation Methods ◽

The Right ◽

Congenital Coronary Artery Anomalies ◽

Myocardial Hypoperfusion

The incidence of congenital coronary artery anomalies is estimated to range between 1% and 2% in the general population. The separate types of coronary artery anomalies are even rarer – the left main coronary artery arising from the right coronary sinus and passing between the thoracic aorta and the pulmonary artery is one of them. In this case, the segment of the artery that courses between the aorta and the pulmonary artery is prone to compression, especially during heavy exercise. Outcomes may be fatal due to myocardial hypoperfusion, which is associated with sudden cardiac death especially among children, young adults, and athletes. Nowadays, innate coronary artery anomalies may be incidentally diagnosed in older age using new investigation methods such as computed tomography angiography.

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A case of anomalous origin of left main coronary artery from the pulmonary artery combined with anomalous aortic origin of the right coronary artery from the left coronary sinus

Coronary Artery Disease ◽

10.1097/mca.0000000000000832 ◽

2020 ◽

Vol 31 (4) ◽

pp. 400-402

Author(s):

Haiyong Wang ◽

Litao Ruan

Keyword(s):

Coronary Artery ◽

Pulmonary Artery ◽

Right Coronary Artery ◽

Coronary Sinus ◽

Left Main Coronary Artery ◽

Anomalous Origin ◽

Left Main ◽

The Right

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Coronary artery–pulmonary artery fistula in pulmonary atresia with ventricular septal defect: report of two surgical cases

Cardiology in the Young ◽

10.1017/s1047951121003796 ◽

2021 ◽

pp. 1-4

Author(s):

Arif Yasin Çakmak ◽

Ilker Kemal Yucel ◽

Ahmet Sasmazel

Keyword(s):

Coronary Artery ◽

Pulmonary Artery ◽

Septal Defect ◽

Left Main Coronary Artery ◽

Ductus Arteriosus ◽

Pulmonary Atresia ◽

Left Main ◽

Aortopulmonary Collateral ◽

The Right ◽

Pulmonary Artery Fistula

Abstract Pulmonary atresia with ventricular septal defect is a complex congenital cardiac anomaly. The blood is supplied to the lungs through a patent ductus arteriosus, a major aortopulmonary collateral artery, or in very rare cases from a coronary artery–pulmonary artery fistula. We present two cases with coronary artery–pulmonary artery fistula which underwent surgical intervention. In our first patient, the main pulmonary artery was supplied from the left main coronary artery. In the second patient, the right pulmonary artery originated from the left main coronary artery and continued to the right lung posteriorly to the aorta, while the left pulmonary artery originated from the patent ductus arteriosus. The difference in our cases is that the coronary artery pulmonary artery fistulas behave like major aortopulmonary collateral arteries originating from the coronary arteries. These fistulas were the main source of pulmonary blood flow.

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