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Anomalous Left Coronary Artery From Right Pulmonary Artery: Epicardial Imaging
Anomalous Left Coronary Artery From Right Pulmonary Artery: Epicardial Imaging Neeraj Awasthy, MD, FNB, and K. S. Iyer, MS
FEATURE ARTICLES
Departments of Pediatric Cardiology and Pediatric Cardiac Surgery, Fortis Escorts Heart Institute, Delhi, India
Fig 1.
E
picardial echocardiography is an important evaluation modality in the operating room. We describe the epicardial echocardiographic findings in an infant who, in the operating room, received a diagnosis of anomalous left coronary artery arising from the proximal right pulmonary artery (ALCARPA). The 10-month-old boy presented with breathing difficulty and on transthoracic echocardiographic evaluation was seen to have evidence of ALCARPA. Sclerosis of the anterolateral papillary muscle was observed, and mild mitral regurgitation was present. The left ventricular ejection fraction was 10%. What was unusual was that the exact site of entry into the pulmonary artery was not identifiable, and the usual
Address correspondence to Dr Awasthy, 123 Anand Kunj, Vikaspuri, New Delhi, India, 110018; e-mail: [email protected].
Ó 2015 by The Society of Thoracic Surgeons Published by Elsevier
Fig 2.
jet of flow reversal could not be demonstrated in the main pulmonary artery. The possible origin of the anomalous coronary artery seemed to be close to the aorta. The answer was obtained when the surgeon demonstrated the origin of the anomalous artery from the proximal right pulmonary artery (RPA) with an intramural course of the proximal left main coronary artery. Epicardial imaging acted as corroborative evidence to the surgeon’s visual observations and demonstrated the origin and the whole extent of the anomalous coronary artery. It was well shown by epicardial echocardiography in the epiaortic view with the probe placed over the aorta (Figs 1 and 2, arrow), shown by color flow mapping with retrograde flow toward the RPA in Figure 1 and color comparison in Figure 2. The child underwent successful translocation of the coronary artery and had a smooth postoperative course.
Ann Thorac Surg 2015;100:1912 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2015.05.062
FEATURE ARTICLES
Departments of Pediatric Cardiology and Pediatric Cardiac Surgery, Fortis Escorts Heart Institute, Delhi, India
Fig 1.
E
picardial echocardiography is an important evaluation modality in the operating room. We describe the epicardial echocardiographic findings in an infant who, in the operating room, received a diagnosis of anomalous left coronary artery arising from the proximal right pulmonary artery (ALCARPA). The 10-month-old boy presented with breathing difficulty and on transthoracic echocardiographic evaluation was seen to have evidence of ALCARPA. Sclerosis of the anterolateral papillary muscle was observed, and mild mitral regurgitation was present. The left ventricular ejection fraction was 10%. What was unusual was that the exact site of entry into the pulmonary artery was not identifiable, and the usual
Address correspondence to Dr Awasthy, 123 Anand Kunj, Vikaspuri, New Delhi, India, 110018; e-mail: [email protected].
Ó 2015 by The Society of Thoracic Surgeons Published by Elsevier
Fig 2.
jet of flow reversal could not be demonstrated in the main pulmonary artery. The possible origin of the anomalous coronary artery seemed to be close to the aorta. The answer was obtained when the surgeon demonstrated the origin of the anomalous artery from the proximal right pulmonary artery (RPA) with an intramural course of the proximal left main coronary artery. Epicardial imaging acted as corroborative evidence to the surgeon’s visual observations and demonstrated the origin and the whole extent of the anomalous coronary artery. It was well shown by epicardial echocardiography in the epiaortic view with the probe placed over the aorta (Figs 1 and 2, arrow), shown by color flow mapping with retrograde flow toward the RPA in Figure 1 and color comparison in Figure 2. The child underwent successful translocation of the coronary artery and had a smooth postoperative course.
Ann Thorac Surg 2015;100:1912 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2015.05.062