Anomalous left coronary artery origin from the nonfacing sinus of pulmonary artery – Successful repair of a rare entity

Abstract

Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart disease, presenting either in isolation or with other cardiac anomalies. The most common presentation is congestive heart failure in infancy, though some may remain asymptomatic till adulthood. A 5-month-old infant with congestive heart failure was diagnosed to have ALCAPA with severe Left ventricular (LV) dysfunction. Unlike the more common variants where the left coronary artery (LCA) arose from the facing sinuses, the LCA arose from the left anterior nonfacing sinus of the pulmonary artery at a considerable distance from the left aortic sinus. This made direct reimplantation of LCA to the aorta challenging. LCA was reimplanted to the aorta using an extrapulmonary baffle made of an autologous pulmonary flap. The postoperative period was uneventful. The LV contractility improved during the follow-up. Early diagnosis and intervention with a novel surgical technique prevented irreversible cardiac complications and mortality.

Keywords

• coronary anomaly
• coronary reimplantation techniques
• left ventricular dysfunction
• myocardial ischemia
• nonfacing sinus of the pulmonary artery