title: [A case of adult type of anomalous origin of left coronary artery from pulmonary artery--with a referential consideration to the disease in Japan].
abstract: A case of a 33-year-old man with anomalous origin of the left coronary artery from the pulmonary artery (ALCP) was reported with a referential consideration to the adult type of ALCP previously reported in Japan. The patient visited our hospital for further examination of cardiac murmur detected on a mass physical checkup. He was found to have a continuous murmur, the loudest in the left sternal border of 3rd intercostal space, and developed evidence of ischemia during the exercise stress test in the ECG leads of L2, L3, aVF, and V2 through V6. In addition, studies using echocardiography and color Doppler-echocardiography detected a hypertrophied intraventricular septum and a pattern of turbulent blood flow in the proximal pulmonary artery. Cardiac catheterization and aortography proved the existence of ALCP with a markedly developed collateral circulation from the right coronary artery to the left coronary artery. After surgical restoration by ligating the anomalous opening of the left coronary artery, and by bypass grafting to the left coronary artery, it was clear that dilation and kinking of the right coronary artery was lessened and hypoperfusion in the anterior left ventricular wall was improved. As far as we know, this case is the 35th of adult type ALCP reported in our country. Results from this case and others suggest that early detection and therapy for adult type ALCP is important from the point of view preventing ischemic progression, and indicate that restoration by ligation and bypass grafting may be one of the effective surgical procedures for ALCP.
authors.affiliation: Second Department of Internal Medicine, Hirosaki University School of Medicine.
authors.forename: H
authors.initials: H
authors.lastname: Akitsu
authors.forename: A
authors.initials: A
authors.lastname: Mikuniya
authors.forename: M
authors.initials: M
authors.lastname: Mikami
authors.forename: F
authors.initials: F
authors.lastname: Kikuchi
authors.forename: Y
authors.initials: Y
authors.lastname: Fujino
authors.forename: A
authors.initials: A
authors.lastname: Hagashiyama
authors.forename: K
authors.initials: K
authors.lastname: Onodera
authors.forename: M
authors.initials: M
authors.lastname: Sawai
authors.forename: M
authors.initials: M
authors.lastname: Oikawa
authors.forename: H
authors.initials: H
authors.lastname: Koie
mesh_terms: D000328:Adult; D006328:Cardiac Catheterization; D003097:Collateral Circulation; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003330:Coronary Vessel Anomalies / Q000175:diagnosis* / Q000601:surgery; D004452:Echocardiography; D004562:Electrocardiography; D005080:Exercise Test; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008403:Mass Screening; D011651:Pulmonary Artery / Q000002:abnormalities*; D011877:Radionuclide Imaging