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Left Coronary Artery Anomalous Origin
Randy R. Richardson, MD; Ryan A. Moore, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Synonyms

          • Anomalous origin of left coronary artery from pulmonary artery (ALCAPA) = Bland-White-Garland (BWG) syndrome
        • Definitions

          • ALCAPA: Most common congenital coronary artery anomaly presenting in children
            • Causes cardiac ischemia & infarction, depressed left ventricular (LV) systolic function, & significant mitral valve regurgitation

        IMAGING

        • General Features

          • Radiographic Findings

            • CT Findings

              • MR Findings

                • Echocardiographic Findings

                  • Angiographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Microscopic Features

                            CLINICAL ISSUES

                            • Presentation

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    Selected References

                                    1. Cavalcanti LRP et al: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) in adults: collateral circulation does not preclude direct reimplantation. J Card Surg. 36(2):731-4, 2021
                                    2. De Rose C et al: Lung ultrasound in congenital cardiac abnormality: ALCAPA. Indian J Pediatr. 88(2):161-4, 2021
                                    3. Tomoaia R et al: The role of multimodal imaging in the diagnosis of an asymptomatic patient with congenital anomaly. Med Ultrason. 23(2):231-4, 2021
                                    4. Wen LY et al: Multimodal cardiac magnetic resonance imaging of ALCAPA syndrome. Eur Heart J. 42(7):798, 2021
                                    5. Jinmei Z et al: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) diagnosed in children and adolescents. J Cardiothorac Surg. 15(1):90, 2020
                                    6. Sadoma D et al: Anomalous left coronary artery from the pulmonary artery (ALCAPA) as a cause of heart failure. Am J Case Rep. 20:1797-800, 2019
                                    7. Bhalgat P et al: Cardiac magnetic resonance imaging, myocardial scar and coronary flow pattern in anomalous origin of left coronary artery from the pulmonary artery. Indian Heart J. 70(2):303-7, 2018
                                    8. Chatterjee A et al: Multimodality imaging of rare adult presentation of ALCAPA treated with Takeuchi repair. JACC Cardiovasc Interv. 11(1):98-9, 2018
                                    9. Agarwal PP et al: Anomalous coronary arteries that need intervention: review of pre- and postoperative imaging appearances. Radiographics. 37(3):740-57, 2017
                                    10. Heermann P et al: Coronary artery anomalies: diagnosis and classification based on cardiac CT and MRI (CMR) - from ALCAPA to anomalies of termination. Rofo. 189(1):29-38, 2017
                                    11. Li RJ et al: Diagnostic value of transthoracic echocardiography in patients with anomalous origin of the left coronary artery from the pulmonary artery. Medicine (Baltimore). 95(15):e3401, 2016
                                    12. Naimo PS et al: Surgical intervention for anomalous origin of left coronary artery from the pulmonary artery in children: a long-term follow-up. Ann Thorac Surg. 101(5):1842-8, 2016
                                    13. Baraona F et al: Coronary arteries in childhood heart disease: implications for management of young adults. J Clin Exp Cardiolog. 2012
                                    14. Shriki JE et al: Identifying, characterizing, and classifying congenital anomalies of the coronary arteries. Radiographics. 32(2):453-68, 2012
                                    15. Fehrenbacher TA et al: Surgery and critical care for anomalous coronary artery from the pulmonary artery. Cardiol Young. 20 Suppl 3:35-43, 2010
                                    16. Peña E et al: ALCAPA syndrome: not just a pediatric disease. Radiographics. 29(2):553-65, 2009
                                    17. Friedman AH et al: Identification, imaging, functional assessment and management of congenital coronary arterial abnormalities in children. Cardiol Young. 17 Suppl 2:56-67, 2007
                                    18. Deibler AR et al: Imaging of congenital coronary anomalies with multislice computed tomography. Mayo Clin Proc. 79(8):1017-23, 2004
                                    19. Frommelt PC et al: Congenital coronary artery anomalies. Pediatr Clin North Am. 51(5):1273-88, 2004
                                    20. Schoenhagen P et al: Noninvasive imaging of coronary arteries: current and future role of multi-detector row CT. Radiology. 232(1):7-17, 2004
                                    Related Anatomy
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Clinical Issues

                                          TERMINOLOGY

                                          • Synonyms

                                            • Anomalous origin of left coronary artery from pulmonary artery (ALCAPA) = Bland-White-Garland (BWG) syndrome
                                          • Definitions

                                            • ALCAPA: Most common congenital coronary artery anomaly presenting in children
                                              • Causes cardiac ischemia & infarction, depressed left ventricular (LV) systolic function, & significant mitral valve regurgitation

                                          IMAGING

                                          • General Features

                                            • Radiographic Findings

                                              • CT Findings

                                                • MR Findings

                                                  • Echocardiographic Findings

                                                    • Angiographic Findings

                                                      • Imaging Recommendations

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            • Microscopic Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Natural History & Prognosis

                                                                  • Treatment

                                                                    DIAGNOSTIC CHECKLIST

                                                                    • Consider

                                                                      Selected References

                                                                      1. Cavalcanti LRP et al: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) in adults: collateral circulation does not preclude direct reimplantation. J Card Surg. 36(2):731-4, 2021
                                                                      2. De Rose C et al: Lung ultrasound in congenital cardiac abnormality: ALCAPA. Indian J Pediatr. 88(2):161-4, 2021
                                                                      3. Tomoaia R et al: The role of multimodal imaging in the diagnosis of an asymptomatic patient with congenital anomaly. Med Ultrason. 23(2):231-4, 2021
                                                                      4. Wen LY et al: Multimodal cardiac magnetic resonance imaging of ALCAPA syndrome. Eur Heart J. 42(7):798, 2021
                                                                      5. Jinmei Z et al: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) diagnosed in children and adolescents. J Cardiothorac Surg. 15(1):90, 2020
                                                                      6. Sadoma D et al: Anomalous left coronary artery from the pulmonary artery (ALCAPA) as a cause of heart failure. Am J Case Rep. 20:1797-800, 2019
                                                                      7. Bhalgat P et al: Cardiac magnetic resonance imaging, myocardial scar and coronary flow pattern in anomalous origin of left coronary artery from the pulmonary artery. Indian Heart J. 70(2):303-7, 2018
                                                                      8. Chatterjee A et al: Multimodality imaging of rare adult presentation of ALCAPA treated with Takeuchi repair. JACC Cardiovasc Interv. 11(1):98-9, 2018
                                                                      9. Agarwal PP et al: Anomalous coronary arteries that need intervention: review of pre- and postoperative imaging appearances. Radiographics. 37(3):740-57, 2017
                                                                      10. Heermann P et al: Coronary artery anomalies: diagnosis and classification based on cardiac CT and MRI (CMR) - from ALCAPA to anomalies of termination. Rofo. 189(1):29-38, 2017
                                                                      11. Li RJ et al: Diagnostic value of transthoracic echocardiography in patients with anomalous origin of the left coronary artery from the pulmonary artery. Medicine (Baltimore). 95(15):e3401, 2016
                                                                      12. Naimo PS et al: Surgical intervention for anomalous origin of left coronary artery from the pulmonary artery in children: a long-term follow-up. Ann Thorac Surg. 101(5):1842-8, 2016
                                                                      13. Baraona F et al: Coronary arteries in childhood heart disease: implications for management of young adults. J Clin Exp Cardiolog. 2012
                                                                      14. Shriki JE et al: Identifying, characterizing, and classifying congenital anomalies of the coronary arteries. Radiographics. 32(2):453-68, 2012
                                                                      15. Fehrenbacher TA et al: Surgery and critical care for anomalous coronary artery from the pulmonary artery. Cardiol Young. 20 Suppl 3:35-43, 2010
                                                                      16. Peña E et al: ALCAPA syndrome: not just a pediatric disease. Radiographics. 29(2):553-65, 2009
                                                                      17. Friedman AH et al: Identification, imaging, functional assessment and management of congenital coronary arterial abnormalities in children. Cardiol Young. 17 Suppl 2:56-67, 2007
                                                                      18. Deibler AR et al: Imaging of congenital coronary anomalies with multislice computed tomography. Mayo Clin Proc. 79(8):1017-23, 2004
                                                                      19. Frommelt PC et al: Congenital coronary artery anomalies. Pediatr Clin North Am. 51(5):1273-88, 2004
                                                                      20. Schoenhagen P et al: Noninvasive imaging of coronary arteries: current and future role of multi-detector row CT. Radiology. 232(1):7-17, 2004