成人左冠状动脉起源于肺动脉（ALCAPA）：侧支循环并不排除直接再植术。
Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) in adults: Collateral circulation does not preclude direct reimplantation.
作者信息
Cavalcanti Luiz Rafael P, Sá Michel Pompeu B O, Escorel Neto Antônio C, Salerno Pedro Rafael, Lima Ricardo C
机构信息
Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Pernambuco, Brazil.
University of Pernambuco - UPE, Recife, Pernambuco, Brazil.
出版信息
J Card Surg. 2021 Feb;36(2):731-734. doi: 10.1111/jocs.15238. Epub 2020 Dec 8.
BACKGROUND
The adult type of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is characterized by late presentation due to collateral coronary flow. Patients often present with long time recurrent angina or dyspnea. Surgical correction can be a challenge due to the vast collateral coronary circulation.
CASE PRESENTATION
A previously healthy 41-year-old male presented in the emergency room referring typical angina and dyspnea. Coronary angiography revealed ALCAPA. Surgical correction was indicated. Under cardiopulmonary bypass, the left main coronary artery ostium was isolated and directly reimplanted in the aorta. The patient was discharged from the hospital without complications and asymptomatic. Control coronary angiography showed enlarged left main coronary artery and regression of the collateral circulation.
CONCLUSION
Even with a well-developed collateral circulation, detachment of the left coronary artery and direct implantation in the aorta is feasible, achieving good long-term results.
背景
成人型左冠状动脉起源于肺动脉（ALCAPA）的特点是由于冠状动脉侧支循环而出现较晚的临床表现。患者常表现为长时间反复发作的心绞痛或呼吸困难。由于广泛的冠状动脉侧支循环，手术矫正可能具有挑战性。
病例报告
一名此前健康的41岁男性因典型心绞痛和呼吸困难就诊于急诊室。冠状动脉造影显示为ALCAPA。指示进行手术矫正。在体外循环下，分离左冠状动脉主干开口并直接重新植入主动脉。患者出院时无并发症且无症状。对照冠状动脉造影显示左冠状动脉主干增粗且侧支循环消退。
结论
即使存在发育良好的侧支循环，分离左冠状动脉并直接植入主动脉也是可行的，可取得良好的长期效果。
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