日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
〒162-0801東京都新宿区山吹町358-5アカデミーセンター Japanese Society of Pediatric Cardiology and Cardiac Surgery Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Pediatric Cardiology and Cardiac Surgery 33(4): 341-342 (2017)
doi:10.9794/jspccs.33.341

Images in Pediatric and Congenital Heart DiseaseImages in Pediatric and Congenital Heart Disease

A Case of Anomalous Left Anterior Descending Coronary Artery from the Pulmonary Artery Combined with Anomalous Right Coronary Artery from the Left Coronary Sinus

1Department of Pediatrics, Kawaguchi Municipal Medical Center ◇ Saitama, Japan

2Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University ◇ Tokyo, Japan

受付日:2016年11月25日Received: November 25, 2016
受理日:2017年6月7日Accepted: June 7, 2017
発行日:2017年7月1日Published: July 1, 2017
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Key words: anomalous left anterior descending; congenital; multi-slice computed tomography

We report a 19 year-old male with no symptoms who was diagnosed as a rare congenital coronary anomaly (CCA). He was previously diagnosed in our center as a small ventricular septal defect. Routine echocardiography indicated abnormal blood flow into the main pulmonary artery (PA), suggesting CCA. Electrocardiogram showed no ischemic changes.

The multi-slice cardiac computed tomography (MSCT) showed an anomalous vessel (AV) originating from the PA, and an anomalous right coronary artery originating from the left coronary sinus (ARCALCS) (Fig. 1).

Pediatric Cardiology and Cardiac Surgery 33(4): 341-342 (2017)

Fig. 1 The multi-slice cardiac computed tomography showing ALADPA and ARCALCS

ALADPA, anomalous left anterior descending from the pulmonary artery; ARCALCS, anomalous right coronary artery originating from the left coronary sinus; RCA, right coronary artery; PA, pulmonary artery; n-LAD, normal left anterior descending.

The AV was morphologically similar to the left anterior descending (LAD) artery, and was mildly enlarged and tortuous. It was located on the right side of the anterior interventricular sulcus (AIVS) and sprouted branches to supply the right ventricular wall. These were thought to be the right ventricular branches of the LAD.1) The normal LAD (n-LAD) originating from the left main coronary artery (LMCA) was smaller than the AV. The n-LAD was located on the left side of the AV along the AIVS and terminated at the cardiac apex. Selective left coronary angiography showed that the blood flow of the AV was supplied by retrograde flow from collaterals of the n-LAD (Fig. 2). These results confirmed that the AV was the anomalous LAD from the PA (ALADPA).

Pediatric Cardiology and Cardiac Surgery 33(4): 341-342 (2017)

Fig. 2 Left coronary angiography showing ALADPA supplied by collaterals from the n-LAD (red circle)

ALADPA, anomalous left anterior descending from the pulmonary artery; n-LAD, normal left anterior descending.

ARCALCS had the separated orifice close to the LMCA and passed the interarterial course. The segments and the branches of ARCALCS were normal for the right coronary artery.

ALADPA is an extremely rare CCA with a frequency of 0.0008%.2) This anomaly may be a cause of sudden cardiac death, ischemia and heart failure in adults.3) Though our case currently has no symptoms because of the existence of the n-LAD, sufficient collaterals to ALADPA and no event of kinking of ARCALCS, he has a possibility of encountering ischemic events in the future. Thus, routine assessment of myocardial ischemia (e.g. exercise treadmill test or stress imaging) is necessary.

In our case, MSCT was useful for diagnosis.

Conflict of interest

The authors have no conflicts of interest to declare.

Note

Supplementary movies are provided online for this article.

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This page was last modified on 2017-08-14T17:30:57.759+09:00


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