Thakut Gowtham, Sanghavi Utkarsh, Gohil Ishan, Kothari Jignesh
Department of Cardiovascular & Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, 380016 Gujarat India.
Indian J Thorac Cardiovasc Surg. 2025 Jan;41(1):61-65. doi: 10.1007/s12055-024-01739-0. Epub 2024 Apr 26.
Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart disease. It presents as myocardial infarction in children; however, the presentation may vary between asymptomatic to progressive heart failure and also death. As a result, diagnosis in living adults is extremely rare. Different techniques have been mentioned for management of ALCAPA presenting in adults. In our retrospective case study, we present two adults, one male and one female, aged 33 and 49 years, respectively, who underwent transpulmonary direct closure of ALCAPA with left internal thoracic artery anastomosis to the left anterior descending artery and saphenous venous graft to obtuse marginal (OM) major, under standard cardiopulmonary bypass, thus forming a two-coronary system. On 5-year follow-up, both patients were doing well on echocardiography with good biventricular function, and follow-up computed tomography (CT) coronary angiography was carried out showing patent grafts. Therefore, establishment of a two-coronary system in adult ALCAPA can be considered as one of the gold standard treatments. In adult ALCAPA, coronary artery bypass grafting (CABG) is superior to other techniques in terms of alleviation of symptoms, survival, procedural ease, and improvement of left ventricular (LV) function.
左冠状动脉起源于肺动脉（ALCAPA）是一种罕见的先天性心脏病。它在儿童中表现为心肌梗死；然而，其表现可能从无症状到进行性心力衰竭甚至死亡不等。因此，在成年患者中诊断出该病极为罕见。对于成年患者中出现的ALCAPA的治疗，已经提及了不同的技术。在我们的回顾性病例研究中，我们介绍了两名成年人，一名男性和一名女性，年龄分别为33岁和49岁，他们在标准体外循环下接受了经肺动脉直接闭合ALCAPA，将左胸廓内动脉与左前降支动脉吻合，并将大隐静脉移植至钝缘支（OM）主干，从而形成了双冠状动脉系统。在5年的随访中，两名患者的超声心动图检查结果良好，双心室功能正常，并且进行了随访计算机断层扫描（CT）冠状动脉造影，显示移植血管通畅。因此，在成年ALCAPA患者中建立双冠状动脉系统可被视为金标准治疗方法之一。在成年ALCAPA患者中，冠状动脉旁路移植术（CABG）在缓解症状、生存率、手术便利性以及改善左心室（LV）功能方面优于其他技术。
