Murthy Avinash, Kim Grace Youngmi, Khawaja Hussain, Sullenberger Lance
Division of Cardiology, 267 Grant Street, Bridgeport Hospital, Bridgeport, CT 06610, USA.
Department of Medicine, Albany Medical Center, Albany, NY 12208, USA.
J Cardiol Cases. 2013 Dec 13;9(1):22-25. doi: 10.1016/j.jccase.2013.09.001. eCollection 2014 Jan.
An otherwise healthy 26-year-old female presented with sudden cardiac arrest. She was resuscitated with unsynchronized cardioversion for ventricular fibrillation. A left heart cardiac catheterization showed anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). Cardiac computed tomographic angiography confirmed this abnormality. She underwent direct translocation of the left main coronary artery to the aorta, and after a stormy postoperative course was discharged home. ALCAPA is a rare congenital abnormality of the coronary system that is associated with early infant mortality and adult sudden death. The use of advanced cardiac imaging has resulted in an increase in the number of diagnosed ALCAPA cases, especially in the adult population, sometimes even in the asymptomatic. The extent of collateral circulation that develops between the right coronary artery and the left coronary artery determines the outcome; the more collateral circulation there is, the less the hypoxic damage to the ventricle. This not only informs us that people survive ALCAPA into adulthood but also highlights the importance for adult cardiologists to be aware of this interesting disease. Corrective surgery remains the treatment of choice. We present a rare case of ALCAPA, with first presentation in adulthood in the form of a malignant ventricular arrhythmia. < Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital abnormality of the coronary system that is associated with early infant mortality and adult sudden death. Hence we feel it is most important to be aware of this entity, especially as the incidence of diagnosed ALCAPA is on the rise in adulthood. Also the images provided and the discussion have high educational value for generalists and cardiologists alike.>.
一名26岁、其他方面健康的女性突发心脏骤停。她因室颤接受了非同步心脏复律复苏。左心导管检查显示左冠状动脉起源于肺动脉（ALCAPA）异常。心脏计算机断层血管造影证实了这一异常。她接受了左冠状动脉直接移位至主动脉的手术，术后经历波折后出院回家。ALCAPA是一种罕见的冠状动脉系统先天性异常，与婴儿早期死亡和成人猝死有关。先进心脏成像技术的应用导致确诊的ALCAPA病例数量增加，尤其是在成人人群中，有时甚至在无症状者中也能发现。右冠状动脉和左冠状动脉之间形成的侧支循环程度决定了预后；侧支循环越多，对心室的缺氧损伤就越小。这不仅告诉我们有人能存活至成年期，还凸显了成年心脏病专家了解这种有趣疾病的重要性。矫正手术仍然是首选治疗方法。我们报告一例罕见的ALCAPA病例，首次表现为成年期的恶性室性心律失常。<左冠状动脉起源于肺动脉（ALCAPA）异常是一种罕见的冠状动脉系统先天性异常，与婴儿早期死亡和成人猝死有关。因此，我们认为了解这一实体非常重要，特别是因为成年期确诊的ALCAPA发病率正在上升。此外，所提供的图像和讨论对普通医生和心脏病专家都具有很高的教育价值。>
