Anomalous origin of left coronary artery from pulmonary artery (ALCAPA)

Anomalous origin of the left coronary artery from the pulmonary artery in children: 15 years experience.

Pediatr Cardiol. 2011 Jan;32(1):24-31. PMID: 20976445

“Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart disease (CHD). Initially, ALCAPA was reported in an anatomic study by Brooks in 1886 [3]. The first clinical description of this anomaly, however, was given by Bland, White, and Garland in 1933 [2], and hence ALCAPA bears the eponym Bland-White-Garland syndrome. An increasing number of ALCAPA cases have been reported recently, but the sample size of each study has been relatively small. This study aimed to illustrate the clinical features, diagnosis, surgical treatment, and long-term prognosis of Chinese children with ALCAPA.”

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The caveats in the diagnosis of anomalous origin of left coronary artery from pulmonary artery (ALCAPA).

Images Paediatr Cardiol. 2010 Jul;12(3):3-8. PMID: 22368564

“Anomalous origin of left coronary artery from pulmonary artery (ALCAPA) is an infrequent, well described, but important anomaly of the coronary origin. Early diagnosis and prompt surgical treatment of the disease can be life saving. However, there are several potential sources of error in the seemingly simple stereotype diagnostic pattern. We report a case of ALCAPA and allude to some of the caveats in the diagnosis of this entity.”

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Anomalous left coronary artery from pulmonary artery (ALCAPA) in infants: a 5-year review in a defined birth cohort.

Eur J Pediatr. 2008 Jan;167(1):43-6. Epub 2007 Feb 16. PMID: 18038147

“Anomalous left coronary artery from pulmonary artery (ALCAPA) is a rare congenital cardiac malformation. It presents predominantly in infancy with features of myocardial ischaemia or cardiac failure and may be mistaken for common paediatric conditions such as colic, reflux or bronchiolitis. With early surgical correction the prognosis is good, but awareness of this condition is essential for prompt diagnosis and referral to a tertiary cardiac centre. In this report we review the five cases that presented during our 5-year study period and discuss the incidence and clinical presentation of ALCAPA among infants. Our observed incidence of 1 in 4243 live births–0.023%–is higher than previously reported. ALCAPA may be more common than previously recognised, and there should be a high index of awareness among paediatricians, paediatric trainees and general practitioners to enable early surgical intervention and improved prognosis for these children.”

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Identification, imaging, functional assessment and management of congenital coronary arterial abnormalities in children.

Cardiol Young. 2007 Sep;17 Suppl 2:56-67. PMID: 18039399

“Anomalous origin of the left coronary artery from the pulmonary trunk occurs with an incidence of approximately 1 in 300,000 children. The degree of left ventricular dysfunction produced likely relates to the development of collateral vessels that arise from the right coronary artery, and provide flow into the left system. Anomalous origin of either the right or the left coronary artery from the opposite sinus of Valsalva can be relatively innocuous, but if the anomalous artery takes an interarterial course between the pulmonary trunk and the aorta, this can underlie sudden death, almost invariably during or immediately following strenuous exercise or competitive sporting events. Distal anomalies of the coronary arteries most commonly involve abnormal connections, or fistulas, between the right or left coronary arterial systems and a chamber or vessel. We discuss the current techniques available for imaging these various lesions, along with their functional assessment, concluding with a summary of current strategies for management.”

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