Gondal Muhammad Umer Riaz, Jyothi Ramachandran Nair Devi Parvathy, Shah Smit, Zafar Muhammad, Hanif Muhammad Asad, McCauley Brian, Hope Earl
Internal Medicine, Reading Hospital, West Reading, USA.
Internal Medicine, Tower Health Medical Group, West Reading, USA.
Cureus. 2024 Jun 9;16(6):e62016. doi: 10.7759/cureus.62016. eCollection 2024 Jun.
Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital malformation. We present a case of an elderly patient with ALCAPA presenting with complete heart block and non-ST-elevation myocardial infarction years after diagnosis and surgical correction. An 81-year-old female with a history of ALCAPA presented to the emergency department with chest pain and progressive mental deterioration. She was bradycardic and hypotensive. An electrocardiogram revealed a complete heart block. Troponin was 4.04 ng/mL. She received atropine and underwent transcutaneous pacing. Left heart catheterization revealed complete occlusion of the mid-left circumflex artery, which was intervened with balloon angioplasty and chronic total occlusion of the right coronary artery. She was supported with temporary transvenous pacing, did not require further pacing support, and was discharged home. Previous records unearthed that in 1988 she had presented with syncope and was diagnosed with ALCAPA, filling from right-to-left collaterals with large and ectatic coronaries. At the time, she underwent surgical correction with excision of the left coronary from the pulmonary artery and reimplantation in the left coronary cusp along the posterior aorta. She had remained asymptomatic after her surgery until this presentation. ALCAPA is extremely rare in adults. Insufficient collaterals to the left ventricle cause inadequate blood supply, leading to ischemia in adults, predisposing them to arrhythmias and risk of sudden death. Adults with ALCAPA remain at increased risk of adverse cardiac events later in life, requiring long-term monitoring.
左冠状动脉起源于肺动脉（ALCAPA）是一种罕见的先天性畸形。我们报告一例老年ALCAPA患者，在诊断和手术矫正多年后出现完全性心脏传导阻滞和非ST段抬高型心肌梗死。一名有ALCAPA病史的81岁女性因胸痛和进行性精神恶化就诊于急诊科。她心动过缓和低血压。心电图显示完全性心脏传导阻滞。肌钙蛋白为4.04 ng/mL。她接受了阿托品治疗并进行了经皮起搏。左心导管检查显示左回旋支中段完全闭塞，行球囊血管成形术干预，右冠状动脉慢性完全闭塞。她接受了临时经静脉起搏支持，不需要进一步的起搏支持，随后出院回家。既往记录显示，1988年她曾出现晕厥，被诊断为ALCAPA，有由右向左的侧支循环供血，冠状动脉粗大且扩张。当时，她接受了手术矫正，将左冠状动脉从肺动脉切除并重新植入后主动脉的左冠状动脉瓣叶。术后她一直无症状，直至此次发病。ALCAPA在成年人中极为罕见。左心室侧支循环不足导致血液供应不充分，致使成年人发生心肌缺血，易引发心律失常和猝死风险。患有ALCAPA的成年人在晚年发生不良心脏事件的风险仍然增加，需要长期监测。
