[Mitral insufficiency in an adult, due to an abnormal left coronary artery arising from the pulmonary trunk: echocardiographic aspects. Apropos of a case].

The case of a 20 year old woman followed up since adolescence for a progressive congestive cardiomyopathy with mitral regurgitation is reported. She was reinvestigated after hospital admission for cardiac decompensation and supraventricular arrhythmias; 2D echocardiography showed signs of severe mitral regurgitation with thickened mitral leaflets prolapsing into a dilated left atrium and, above all, abnormal diastolic wall motion related to restriction of left ventricular filling with no apparent systolic dysfunction : pulsed Doppler studies confirmed the diagnosis of mitral regurgitation but also showed retrograde diastolic flow in the aortic arch (without aortic regurgitation) and in the main pulmonary artery. Angiography showed these disturbances to be due to an abnormal origin of the left coronary artery in the main pulmonary artery. Reimplantation of the left coronary in the aorta and mitral annuloplasty were justified by the poor spontaneous prognosis of this congenital abnormality which has rarely been described in adults.