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Bland-White-Garland Syndrome
Darragh Brady, MD; David Murphy, MD; Jonathan D. Dodd, MD, MSc, MRCPI, FFR(RCSI)
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Anomalous origin of left main coronary artery from pulmonary artery (ALCAPA)
            • Coronary arterial circulation is established by 45 days gestation in fetus
              • Possible causes of ALCAPA
                • Abnormal division of conotruncus
                • Abnormal involution of endothelial buds on sinuses of Valsalva
                • Endothelial bud may persist on pulmonary sinus and attach to developing left main coronary artery

          IMAGING

          • General Features

            • Imaging Recommendations

              DIFFERENTIAL DIAGNOSIS

                PATHOLOGY

                • General Features

                  CLINICAL ISSUES

                  • Presentation

                    • Demographics

                      • Natural History & Prognosis

                        • Treatment

                          DIAGNOSTIC CHECKLIST

                          • Image Interpretation Pearls

                            Selected References

                            1. Agarwal PP et al: Anomalous coronary arteries that need intervention: Review of pre- and postoperative imaging appearances. Radiographics. 37(3):740-757, 2017
                            2. Duan X et al: Anomalous origin of the left coronary artery from the pulmonary artery in infants: imaging findings and clinical implications of cardiac computed tomography. J Comput Assist Tomogr. 39(2):189-95, 2015
                            3. Peña E et al: ALCAPA syndrome: not just a pediatric disease. Radiographics. 29(2):553-65, 2009
                            4. Bland EF, White PD, Garland J. Congenital anomalies of coronary arteries. Report of unusual case associated with cardiac hypertrophy. Am Heart J. 1932-1933;8:787–801.
                            5. Kochar A et al: Coronary Artery Anomalies: When You Need to Worry. Curr Cardiol Rep. 19(5):39, 2017
                            6. Pursnani A et al: Coronary CTA assessment of coronary anomalies. J Cardiovasc Comput Tomogr. 6(1):48-59, 2012
                            7. Yau JM et al: Anomalous origin of the left coronary artery from the pulmonary artery in adults: a comprehensive review of 151 adult cases and a new diagnosis in a 53-year-old woman. Clin Cardiol. 34(4):204-10, 2011
                            8. Ichikawa M et al: Detection of Bland-White-Garland syndrome by multislice computed tomography in an elderly patient. Int J Cardiol. 114(2):288-90, 2007
                            9. Kim SY et al: Coronary artery anomalies: classification and ECG-gated multi-detector row CT findings with angiographic correlation. Radiographics. 26(2):317-334, 2006
                            10. Mohrs OK et al: Assessment of nonviable myocardium due to Bland-White-Garland syndrome using contrast-enhanced MRI. J Cardiovasc Magn Reson. 6(4):941-4, 2004
                            11. Dodge-Khatami A et al: Anomalous origin of the left coronary artery from the pulmonary artery: collective review of surgical therapy. Ann Thorac Surg. 74(3):946-55, 2002
                            12. Takeuchi S et al: New surgical method for repair of anomalous left coronary artery from pulmonary artery. J Thorac Cardiovasc Surg. 78(1):7-11, 1979
                            Related Anatomy
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                            Related Differential Diagnoses
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                            References
                            Tables

                            Tables

                            KEY FACTS

                            • Terminology

                              • Imaging

                                • Top Differential Diagnoses

                                  • Clinical Issues

                                    TERMINOLOGY

                                    • Definitions

                                      • Anomalous origin of left main coronary artery from pulmonary artery (ALCAPA)
                                      • Coronary arterial circulation is established by 45 days gestation in fetus
                                        • Possible causes of ALCAPA
                                          • Abnormal division of conotruncus
                                          • Abnormal involution of endothelial buds on sinuses of Valsalva
                                          • Endothelial bud may persist on pulmonary sinus and attach to developing left main coronary artery

                                    IMAGING

                                    • General Features

                                      • Imaging Recommendations

                                        DIFFERENTIAL DIAGNOSIS

                                          PATHOLOGY

                                          • General Features

                                            CLINICAL ISSUES

                                            • Presentation

                                              • Demographics

                                                • Natural History & Prognosis

                                                  • Treatment

                                                    DIAGNOSTIC CHECKLIST

                                                    • Image Interpretation Pearls

                                                      Selected References

                                                      1. Agarwal PP et al: Anomalous coronary arteries that need intervention: Review of pre- and postoperative imaging appearances. Radiographics. 37(3):740-757, 2017
                                                      2. Duan X et al: Anomalous origin of the left coronary artery from the pulmonary artery in infants: imaging findings and clinical implications of cardiac computed tomography. J Comput Assist Tomogr. 39(2):189-95, 2015
                                                      3. Peña E et al: ALCAPA syndrome: not just a pediatric disease. Radiographics. 29(2):553-65, 2009
                                                      4. Bland EF, White PD, Garland J. Congenital anomalies of coronary arteries. Report of unusual case associated with cardiac hypertrophy. Am Heart J. 1932-1933;8:787–801.
                                                      5. Kochar A et al: Coronary Artery Anomalies: When You Need to Worry. Curr Cardiol Rep. 19(5):39, 2017
                                                      6. Pursnani A et al: Coronary CTA assessment of coronary anomalies. J Cardiovasc Comput Tomogr. 6(1):48-59, 2012
                                                      7. Yau JM et al: Anomalous origin of the left coronary artery from the pulmonary artery in adults: a comprehensive review of 151 adult cases and a new diagnosis in a 53-year-old woman. Clin Cardiol. 34(4):204-10, 2011
                                                      8. Ichikawa M et al: Detection of Bland-White-Garland syndrome by multislice computed tomography in an elderly patient. Int J Cardiol. 114(2):288-90, 2007
                                                      9. Kim SY et al: Coronary artery anomalies: classification and ECG-gated multi-detector row CT findings with angiographic correlation. Radiographics. 26(2):317-334, 2006
                                                      10. Mohrs OK et al: Assessment of nonviable myocardium due to Bland-White-Garland syndrome using contrast-enhanced MRI. J Cardiovasc Magn Reson. 6(4):941-4, 2004
                                                      11. Dodge-Khatami A et al: Anomalous origin of the left coronary artery from the pulmonary artery: collective review of surgical therapy. Ann Thorac Surg. 74(3):946-55, 2002
                                                      12. Takeuchi S et al: New surgical method for repair of anomalous left coronary artery from pulmonary artery. J Thorac Cardiovasc Surg. 78(1):7-11, 1979