Cardiorespiratory Unit, UCL Institute of Cardiovascular Sciences & Great Ormond Street Hospital for Children, London, UK.
J Cardiovasc Magn Reson. 2011 May 16;13(1):27. doi: 10.1186/1532-429X-13-27.
Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare coronary artery anomaly. This study shows the role of cardiovascular magnetic resonance (CMR) in assessing young patients following surgical repair of ALCAPA.
6 patients, aged 9-21 years, with repaired ALCAPA (2 Tackeuchi method, 4 direct re-implantation) underwent CMR because of clinical suspicion of myocardial ischemia. Imaging used short and long axis cine images (assess ventricular function), late-gadolinium enhancement (LGE) (detect segmental myocardial fibrosis), adenosine stress perfusion (detect reversible ischaemia) and 3D whole-heart imaging (visualize proximal coronary arteries).
The left ventricular (LV) global systolic function was preserved in all patients (mean LV ejection fraction = 62.7% ± 4.23%). The LV volumes were within the normal ranges, (mean indexed LVEDV = 75.4 ± 3.5 ml/m², LVESV = 31.6 ± 9.4 ml/m²). In 1 patient, hypokinesia of the anterior segments was visualized. Five patients showed sub-endocardial LGE involving the basal, antero-lateral wall and the anterior papillary muscle. Three patients had areas of reversible ischemia. In these 3, 3D whole-heart MRA showed that the proximal course of the left coronary artery was occluded (confirmed with cardiac catheterisation).
CMR is a good, non-invasive, radiation-free investigation in the post-surgical evaluation of ALCAPA. In referred patients we show that basal, antero-lateral sub-endocardial myocardial fibrosis is a characteristic finding. Furthermore, stress adenosine CMR perfusion, can identify reversible ischemia in this group, and was indicative of left coronary artery occlusion.
左冠状动脉异常起源于肺动脉（ALCAPA）是一种罕见的冠状动脉异常。本研究显示了心血管磁共振（CMR）在评估接受 ALCAPA 手术后的年轻患者中的作用。
6 名年龄在 9-21 岁的患者，接受过 ALCAPA 修复术（2 例采用 Tackeuchi 法，4 例采用直接再植入术），由于临床怀疑心肌缺血而行 CMR 检查。影像学采用短轴和长轴电影图像（评估心室功能）、晚期钆增强（LGE）（检测节段性心肌纤维化）、腺苷应激灌注（检测可逆性缺血）和 3D 全心成像（可视化近端冠状动脉）。
所有患者的左心室（LV）整体收缩功能均正常（平均 LV 射血分数=62.7%±4.23%）。LV 容积均在正常范围内，（平均指数化 LVEDV=75.4±3.5ml/m²，LVESV=31.6±9.4ml/m²）。1 例患者前节段出现运动障碍。5 例患者显示基底、前外侧壁和前乳头肌的心肌内 LGE。3 例患者存在可逆转的缺血区。在这 3 例患者中，3D 全心 MRA 显示左冠状动脉近端行程闭塞（经心导管检查证实）。
CMR 是一种良好的、非侵入性的、无辐射的 ALCAPA 术后评估方法。在被转诊的患者中，我们显示基底、前外侧壁心肌内下壁纤维化是一种特征性发现。此外，腺苷应激 CMR 灌注可以识别该组患者的可逆性缺血，提示左冠状动脉闭塞。
