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Coronary Arterial and Venous Disease
Published in Paul Schoenhagen, Frank Dong, Cardiac CT Made Easy, 2023
Other clinical indications for coronary CTA may include:Proximal coronary dissection (Figure 8.30). It is important to remember that assessment of coronary dissection in more distal vessel segments is unreliable with CT.113,114Pre-interventional assessment of lesion calcification and assessment of unclear left main coronary artery lesions (Figures 8.31–8.35). Non-stenotic forms of atherosclerotic disease including diffuse coronary ectasia and focal aneurysmal dilatation (Figures 8.36 and 8.37). Non-atherosclerotic aneurysms (Figures 8.38–8.41) Coronary fistulas (Figure 8.42) Coronary anomalies are described in Chapter 13. As an example, a patient with ALCAPA is shown in Figure 8.43
Congenital coronary artery anomalies
Published in Jana Popelová, Erwin Oechslin, Harald Kaemmerer, Martin G St John Sutton, Pavel Žáček, Congenital Heart Disease in Adults, 2008
Jana Popelová, Erwin Oechslin, Harald Kaemmerer, Martin G St John Sutton, Pavel Žáček
ALCAPA is usually an isolated anomaly; however, it may also be associated with other congenital heart diseases (CHD), such as patent ductus arteriosus, ventricular septal defect, tetralogy of Fallot, coarctation of the aorta, etc. In rare cases, the right coronary artery may also arise from the pulmonary artery.
Anomalous origin of the left coronary artery from pulmonary artery misdiagnosed as postpartum cardiomyopathy
Published in Baylor University Medical Center Proceedings, 2020
Subash Nepal, Robert L. Carhart, Suhayb Kadura, Stephany Barreto, Indrit Greca
Anomalous origin of the left coronary artery from pulmonary artery (ALCAPA) is a rare but hemodynamically significant congenital heart disease. ALCAPA syndrome is reported to be present in 1 per 300,000 live births, accounting for 0.25% to 0.5% of all congenital heart diseases.1 Krause and Brooks first reported ALCAPA in 1865 and 1885, respectively.2 Because it is predominantly present in newborns and has a high mortality rate without surgery, diagnosis in adults is rare and information is derived mainly from isolated case reports or extrapolated pediatric cases. Two types of ALCAPA syndrome have been described, and the classic manifestation is symptom onset in the first or second months when the pulmonary artery pressure falls after the closure of the ductus arteriosus.3 Many die from ischemic cardiomyopathy and endocardial fibrosis.4 Although exertional dyspnea and angina pectoris are the predominant symptoms in adults, sudden cardiac death and ventricular fibrillation have also been reported.4 Our patient survived to adulthood due to the formation of an extensive network of collaterals from her right to left coronary arteries, became symptomatic in the postpartum period, and presented with exertional angina pectoris, palpitation, and dyspnea.
Pediatric ventricular assist devices: what are the key considerations and requirements?
Published in Expert Review of Medical Devices, 2020
Roland Hetzer, Mariano Francisco del Maria Javier, Eva Maria Javier Delmo
The Medtronic Bio-Medicus Pump has been used to support pediatric patients with postoperative cardiac failure and a debilitating heart defect known as anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) [98,99]. From 1989 to 1996, a Bio-Medicus pump was used in 34 pediatric patients weighing less than 6 kg [99]. These patients were kept sedated and received vasodilators, antibiotics, nutrition, and periodic infusions of fresh plasma and platelets. The extracorporeal assistance reduced preload and wall stresses in each patient. Despite improvement, 10 patients died due to irreversible myocardial failure. Duncan et al. [93] further reported that 29 pediatric patients were supported with a Bio-Medicus pump. In the patients with ALCAPA or cardiomyopathy, there was a 71% survival rate. In the group that received a transplant after support, there was a 50% survival rate with fewer occurrences of neurologic complications and blood trauma compared with other control groups. Other common complications included recurrent bleeding, multisystem organ failure, or irreversible cardiac disease [99,100].
Cardiac regeneration in a newborn: what does this mean for future cardiac repair research?
Published in Expert Review of Cardiovascular Therapy, 2018
Bernhard J Haubner, Thomas Schuetz, Josef M Penninger
Besides the elucidation of the underlying mechanism for neonatal cardiac repair, one key question remained: Can one translate these models to the human heart considering the fundamental differences in basic cardiac physiology? Talking to pediatric cardiologists we learned from their experience that human neonatal hearts still possess an enormous cardiac plasticity and can even recover functions after removal of the causative harmful conditions. For instance, the ALCAPA syndrome (Anomalous Left Coronary Artery From the Pulmonary Artery) designates a congenital pediatric heart disease that causes myocardial ischemia [20]. Currently, the only curative approach is cardiac surgery with correction of the coronary malformation. Whereas early correction within the first year of age leads to complete recovery of the heart, delayed diagnosis most often ends in damage and ultimately ischemic cardiomyopathy [20]. Encouraged by the clinical experience, we found a handful of documented cases of human neonatal myocardial infarctions. Perinatal cardiac infarction is a very rare clinical event, primarily due to malformation of the heart or coagulation diseases. Since such events are accompanied with high mortality, all the clinical case reports focused on the description of diagnosis and emergency, and critical care treatment in the acute setting. In the discussions, the authors hinted at a good outcome as long as the baby survived the initial ischemic event, without further descriptions (References within Reference [20])