Anomalous origin of the left coronary artery from the pulmonary artery in an adult pregnant patient: surgical and percutaneous myocardial revascularization.
An anomalous origin of the left coronary artery from the pulmonary artery (Bland-White-Garland syndrome) was diagnosed in a 31-year-old woman complaining of angina at 10 weeks of gestation. After termination of pregnancy, the patient underwent surgical repair with ligation of the left coronary artery at the ostium, and a single bypass graft with a left internal thoracic artery to the left anterior descending coronary artery. Angiography, performed at 6 months of follow-up, showed stenosis of the distal anastomosis of the graft that was treated with angioplasty and deployment of a paclitaxel-eluting stent. After 9 months the patient was symptom-free and angiography excluded in-stent restenosis. Experience with the surgical repair of the anomaly is limited by the rarity of this condition; in particular, it has never been reported as a first diagnosis during pregnancy. In the discussion, we analyze the efficacy and limits of the different current strategies for the surgical repair of this rare, but potentially life-threatening, congenital coronary anomaly.
Zavalloni
Dennis
D
Division of Interventional Cardiology, Istituto Clinico Humanitas, Rozzano, MI, Italy. dennis.zavalloni_parenti@humanitas.it
Belli
Guido
G
Caratti
Alberto
A
Presbitero
Patrizia
P
D000015:Abnormalities, Multiple / Q000175:diagnosis / Q000628:therapy; D000032:Abortion, Therapeutic / Q000379:methods; D000328:Adult; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging / Q000628:therapy*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D009204:Myocardial Revascularization / Q000379:methods; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000628:therapy*; D011261:Pregnancy Trimester, First; D011651:Pulmonary Artery / Q000002:abnormalities*; D018570:Risk Assessment; D016896:Treatment Outcome