Harada Takashi, Morimoto Hironobu, Echie Yuki, Futagami Daisuke, Katayama Keijiro, Mukai Shogo, Ozawa Takaya
Department of Cardiovascular Surgery, Fukuyama Cardiovascular Hospital, Fukuyama, Hiroshima, Japan.
Department of Cardiology, Fukuyama Cardiovascular hospital, Fukuyama, Hirosima, Japan.
Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.24-0066. Epub 2025 Mar 21.
An anomalous origin of the left coronary artery (LCA) from the pulmonary artery (PA) (ALCAPA) is a rare congenital abnormality associated with high rates of early infant mortality and sudden death in adults.
A 56-year-old woman with acute left lower extremity arterial occlusion was diagnosed with an adult ALCAPA with a mass in the left atrial appendage. Preoperative echocardiography revealed left ventricular hypokinesis posteroinferior to the lateral wall and moderate mitral valve regurgitation, with a mass in the left atrial appendage. Coronary angiography revealed ALCAPA and dilatation of both coronary arteries. Myocardial scintigraphy revealed infarction of the posteroinferior wall and severe ischemia of the lateral wall of the left ventricle. We occluded the LCA entry from the inside of the PA and performed a left internal thoracic artery-to-left anterior descending artery (LITA-LAD) bypass, mitral annulus plasty, and resection of the mass together with the left atrial appendage. Because of residual myocardial blood flow from the collateral vessels, we cooled the temperature to 28°C to induce cardiac arrest. Postoperative coronary angiography indicated a good LITA-LAD flow and improvement in left ventricular contractility. Myocardial scintigraphy revealed improvement in ischemia. Pathological examination revealed that the mass in the left atrial appendage was a thrombus. The patient's postoperative course was uneventful. She was discharged on postoperative day 16 and was given oral warfarin as anticoagulation therapy. Six months later, the follow-up evaluation was uneventful, and the patient was free of any symptoms of heart failure.
We encountered a very rare case of ALCAPA complicated by a left intra-atrial mass following acute lower extremity artery occlusion. We performed LITA-LAD bypass, mitral annulus plasty, and resection of the mass along with the left atrial appendage. Due to residual myocardial blood flow from the collateral circulation, we cooled the temperature to 28°C in preparation for inducing cardiac arrest. The postoperative course was uneventful.
左冠状动脉（LCA）起源于肺动脉（PA）（ALCAPA）是一种罕见的先天性异常，与婴儿早期高死亡率及成人猝死率相关。
一名56岁女性，因急性左下肢动脉闭塞被诊断为成人ALCAPA，左心耳有肿物。术前超声心动图显示左心室侧壁后下运动减弱及中度二尖瓣反流，左心耳有肿物。冠状动脉造影显示ALCAPA及双冠状动脉扩张。心肌闪烁显像显示左心室下后壁梗死及侧壁严重缺血。我们从肺动脉内部封堵左冠状动脉入口，并进行了左胸廓内动脉至左前降支动脉（LITA-LAD）搭桥、二尖瓣环成形术，以及连同左心耳一起切除肿物。由于侧支血管有残余心肌血流，我们将体温降至28°C以诱导心脏停搏。术后冠状动脉造影显示LITA-LAD血流良好，左心室收缩功能改善。心肌闪烁显像显示缺血改善。病理检查显示左心耳肿物为血栓。患者术后恢复顺利。术后第16天出院，给予口服华法林抗凝治疗。6个月后，随访评估无异常，患者无任何心力衰竭症状。
我们遇到了一例非常罕见的急性下肢动脉闭塞后并发左心房肿物的ALCAPA病例。我们进行了LITA-LAD搭桥、二尖瓣环成形术，以及连同左心耳一起切除肿物。由于侧支循环有残余心肌血流，我们将体温降至28°C以准备诱导心脏停搏。术后恢复顺利。
