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Anomalous origin of additional coronary artery arising from the pulmonary artery in complex congenital heart disease
Cardiovascular Pathology 17 (2008) 190 – 191
Images in Cardiovascular Pathology
Anomalous origin of additional coronary artery arising from the pulmonary artery in complex congenital heart disease Emanuela Angelia,4, Carlo Pace Napoleonea, Guido Oppidoa, Sofia Martı`n-Sua`rezb, Gaetano Gargiuloa a
Pediatric Cardiac Surgery Unit, University of Bologna, Policlinico S. Orsola Malpighi, 40138 Bologna, Italy Department of Cardiac Surgery, University of Bologna, Policlinico S. Orsola Malpighi, 40138 Bologna, Italy
b
Received 1 February 2007; received in revised form 23 March 2007; accepted 31 March 2007
Abstract Anomalous origin of coronary arteries is a rare congenital defect and usually presents as an isolated defect. In only 5% of cases, it may be associated with other cardiac anomalies. In this article, we present a case of a newborn with a very complex congenital cardiac disease accompanied with an anomalous origin of an additional coronary artery. D 2008 Published by Elsevier Inc. Keywords: Anomalous origin of coronary artery; Congenital cardiac defects
In December 2006, a newborn patient of 3.5 kg was referred to our institution with prenatal diagnosis of Type A interrupted aortic arch and aortic pulmonary window. A corrective surgery was planned, and during the operation, an anomalous artery branch was found. The right and left coronary ostia had a normal origin and course. There was an extra coronary artery arising from the anterior side of the pulmonary artery (PA) trunk (Fig. 1). It followed the conal artery path with collateral branches toward the left anterior descending and the right coronary arteries. This coronary artery was ligated at its origin without any electrocardiographic modification. Successful repair of the aortic arch was performed by using moderate hypothermia and antegrade selective cerebral perfusion with the technique previously described [1]. The aortopulmonary window was closed with a clip. The postoperative course was smooth and uncomplicated, and the patient was discharged after 10 days. Anomalous origin of coronary arteries is a rare congenital defect occurring with a incidence of 0.25–0.5% of all 4 Corresponding author. Pediatric Cardiac Surgery Unit, University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italia. Tel.: +39 051 6363156; fax: +39 051 6363157. E-mail address: [email protected] (E. Angeli). 1054-8807/08/$ – see front matter D 2008 Published by Elsevier Inc. doi:10.1016/j.carpath.2007.03.007
Fig. 1. Intraoperative picture of coronary artery arising from the PA. AC, additional coronary; LAD, left anterior descending coronary artery.
E. Angeli et al. / Cardiovascular Pathology 17 (2008) 190–191
congenital defects [2]. Usually, it presents as an isolated defect, and in only the 5% of cases, it may be associated with other cardiac anomalies [3–5]. In the present case, the normal origin of both mains coronary arteries allowed us to ligate the badditionalQ coronary artery without consequences. References [1] Oppido G, et al. Moderately hypothermic cardiopulmonary bypass and low-flow antegrade selective cerebral perfusion for neonatal aortic arch surgery. Ann Thorac Surg 2006;82(6):2233 – 9.
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[2] Dodge-Khatami A, Mavroudis C, Backer CL. Anomalous origin of the left coronary artery from the pulmonary artery: collective review of surgical therapy. Ann Thorac Surg 2002;74:946 – 55. [3] Takimura CK, Nakamoto A, Hotta VT, Campos MF, Malamo M, Otsubo R. Anomalous origin of the left coronary artery from the pulmonary artery: report of an adult case. Arq Bras Cardiol 2002; 78:309 – 14. [4] Frommelt PC, Frommelt MA. Congenital coronary artery anomalies. Pediatr Clin North Am 2004;51(5):1273 – 88. [5] Sqrqcq H, Tatly E, Deoirmenci A, KurtoW N. Anomalous origin of coronary arteries from three separate ostiums in the right sinus of Valsalva: three case reports and review of the literature. Int J Cardiol 2006;106(2):264 – 7.
Images in Cardiovascular Pathology
Anomalous origin of additional coronary artery arising from the pulmonary artery in complex congenital heart disease Emanuela Angelia,4, Carlo Pace Napoleonea, Guido Oppidoa, Sofia Martı`n-Sua`rezb, Gaetano Gargiuloa a
Pediatric Cardiac Surgery Unit, University of Bologna, Policlinico S. Orsola Malpighi, 40138 Bologna, Italy Department of Cardiac Surgery, University of Bologna, Policlinico S. Orsola Malpighi, 40138 Bologna, Italy
b
Received 1 February 2007; received in revised form 23 March 2007; accepted 31 March 2007
Abstract Anomalous origin of coronary arteries is a rare congenital defect and usually presents as an isolated defect. In only 5% of cases, it may be associated with other cardiac anomalies. In this article, we present a case of a newborn with a very complex congenital cardiac disease accompanied with an anomalous origin of an additional coronary artery. D 2008 Published by Elsevier Inc. Keywords: Anomalous origin of coronary artery; Congenital cardiac defects
In December 2006, a newborn patient of 3.5 kg was referred to our institution with prenatal diagnosis of Type A interrupted aortic arch and aortic pulmonary window. A corrective surgery was planned, and during the operation, an anomalous artery branch was found. The right and left coronary ostia had a normal origin and course. There was an extra coronary artery arising from the anterior side of the pulmonary artery (PA) trunk (Fig. 1). It followed the conal artery path with collateral branches toward the left anterior descending and the right coronary arteries. This coronary artery was ligated at its origin without any electrocardiographic modification. Successful repair of the aortic arch was performed by using moderate hypothermia and antegrade selective cerebral perfusion with the technique previously described [1]. The aortopulmonary window was closed with a clip. The postoperative course was smooth and uncomplicated, and the patient was discharged after 10 days. Anomalous origin of coronary arteries is a rare congenital defect occurring with a incidence of 0.25–0.5% of all 4 Corresponding author. Pediatric Cardiac Surgery Unit, University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italia. Tel.: +39 051 6363156; fax: +39 051 6363157. E-mail address: [email protected] (E. Angeli). 1054-8807/08/$ – see front matter D 2008 Published by Elsevier Inc. doi:10.1016/j.carpath.2007.03.007
Fig. 1. Intraoperative picture of coronary artery arising from the PA. AC, additional coronary; LAD, left anterior descending coronary artery.
E. Angeli et al. / Cardiovascular Pathology 17 (2008) 190–191
congenital defects [2]. Usually, it presents as an isolated defect, and in only the 5% of cases, it may be associated with other cardiac anomalies [3–5]. In the present case, the normal origin of both mains coronary arteries allowed us to ligate the badditionalQ coronary artery without consequences. References [1] Oppido G, et al. Moderately hypothermic cardiopulmonary bypass and low-flow antegrade selective cerebral perfusion for neonatal aortic arch surgery. Ann Thorac Surg 2006;82(6):2233 – 9.
191
[2] Dodge-Khatami A, Mavroudis C, Backer CL. Anomalous origin of the left coronary artery from the pulmonary artery: collective review of surgical therapy. Ann Thorac Surg 2002;74:946 – 55. [3] Takimura CK, Nakamoto A, Hotta VT, Campos MF, Malamo M, Otsubo R. Anomalous origin of the left coronary artery from the pulmonary artery: report of an adult case. Arq Bras Cardiol 2002; 78:309 – 14. [4] Frommelt PC, Frommelt MA. Congenital coronary artery anomalies. Pediatr Clin North Am 2004;51(5):1273 – 88. [5] Sqrqcq H, Tatly E, Deoirmenci A, KurtoW N. Anomalous origin of coronary arteries from three separate ostiums in the right sinus of Valsalva: three case reports and review of the literature. Int J Cardiol 2006;106(2):264 – 7.