Cambronero-Cortinas Esther, Moratalla-Haro Pedro, González-García Ana Elvira, Oliver-Ruiz José María
Cardiology Department, Royal Brompton and Harefield Hospital, Sydney Street, London SW3 6NP, UK.
Nursing Faculty, Castilla-La Mancha University, Albacete, Spain.
Eur Heart J Case Rep. 2020 Sep 19;4(5):1-5. doi: 10.1093/ehjcr/ytaa257. eCollection 2020 Oct.
Anomalous origin of the left coronary artery (LCA) from the pulmonary artery (ALCAPA) is an unusual congenital heart defect which affects approximately 1 in 300 000 live births and accounts for 0.5% of all congenital heart disease. Without surgical intervention, most patients die in infancy (nearly 90%).
We present a rare case of an asymptomatic 67-year-old female. Transthoracic echocardiography demonstrated a dilated right coronary artery (RCA) and multiple collaterals. ALCAPA was confirmed by multidetector computed tomography. The left main artery was seen originating from the pulmonary artery and well-developed collaterals were visualized between the RCA and LCA. No areas of myocardial infarction were identified on cardiac magnetic resonance. Stress studies showed no inducible ischaemia.
Our clinical case of an ALCAPA patient who survived and remained asymptomatic to their late 60's, highlights the importance of well-collateralized and pressurized coronary system to maintain adequate myocardial perfusion. Physicians should be aware of this congenital anomaly as appropriate early diagnosis is crucial to prevent irreversible myocardial damage, acute ischaemia, and arrhythmias, and can improve patient outcomes. Surgical treatment is suggested irrespective of symptomatology or the presence of inducible myocardial ischaemia.
左冠状动脉（LCA）起源于肺动脉（ALCAPA）是一种罕见的先天性心脏缺陷，在每30万例活产中约有1例受影响，占所有先天性心脏病的0.5%。未经手术干预，大多数患者在婴儿期死亡（近90%）。
我们报告一例罕见的67岁无症状女性病例。经胸超声心动图显示右冠状动脉（RCA）扩张和多处侧支循环。多排螺旋计算机断层扫描证实为ALCAPA。可见左主干动脉起源于肺动脉，RCA和LCA之间可见发育良好的侧支循环。心脏磁共振成像未发现心肌梗死区域。负荷试验显示无诱发性缺血。
我们的临床病例是一名存活至60多岁且无症状的ALCAPA患者，这突出了良好的侧支循环和有压力的冠状动脉系统对维持足够心肌灌注的重要性。医生应了解这种先天性异常，因为早期适当诊断对于预防不可逆的心肌损伤、急性缺血和心律失常至关重要，并且可以改善患者的预后。无论有无症状或是否存在诱发性心肌缺血，均建议进行手术治疗。
