Anomalous origin of the left coronary artery from the pulmonary artery. Echocardiographic diagnosis.
The experience with echocardiographic diagnosis of five cases of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA) is reviewed.


METHODS
all cases with a diagnosis of ALCAPA during a 10 year period were included.


RESULTS
two age groups were clearly identified: infants and older patients. In the former, the echocardiographic findings included a dilated left ventricle with low ejection fraction (19% and 26%), mitral regurgitation, dilated right coronary artery and difficulties in identifying the origin of the left coronary artery. An 11-year-old asymptomatic boy, a 17-year-old young woman with dyspnea on effort and a 55-year-old woman with angina formed the older group. In these three cases, an abnormal upward flow was detected within the ventricular septum related to the collaterals and the inverse flow of the anterior descending artery. A reverse flow within the origin of the left coronary artery, probably related to an origin in the pulmonary artery, was observed. In all five cases the diagnosis was corroborated using selective right coronary artery angiography.


CONCLUSIONS
In the infants, the dilated left ventricle with impaired systolic function, mitral regurgitation and dilated right coronary artery make it necessary to discard the ALCAPA diagnosis. In the older group, even in asymptomatic patients, an abnormal ascending flow within the ventricular septum, combined with a dilated coronary artery, was the most reliable echocardiographic evidence for a diagnosis of ALCAPA.
Alva
Carlos
C
Congenital Heart Disease Department, Cardiology Hospital, Centro Médico Nacional Siglo XXI, Mexico City CP 06720, Mexico. echoca@yahoo.com
Gómez
Felipe David
FD
Jiménez-Arteaga
Santiago
S
Martínez-Sánchez
Arturo
A
Ortegón-Cardeña
José
J
Yánez
Lucelli
L
Riera-Kinkel
Carlos
C
D000015:Abnormalities, Multiple / Q000000981:diagnostic imaging*; D000293:Adolescent; D002648:Child; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D014463:Ultrasonography