ALCAPA – Anomalous Left Coronary Artery from the Pulmonary Artery

Embryology is wonderful. Please think seriously about it. It is strange to grow from one cell to all complex structures that form our organs. The shocking thing is that it happens correctly, and when it is not perfect it should not be surprising. Unfortunately, terrible results will become obvious when it is not perfect. We have previously discussed some of the problems with chromosomes that can not move properly (such as Down's syndrome). We also examined what happens if the artery is not correctly formed (eg, AVM). Let's think about the reason why the artery finds errors in adjacent structures - pulmonary artery anomaly left coronary artery (ALCAPA)

Left coronary artery anomaly from the pulmonary artery is a life-threatening congenital abnormality

Early, when the pulmonary blood pressure is high, there is a flow from the pulmonary artery to the myocardium.

Later, as pulmonary vascular resistance decreases, blood "stolen" from the myocardium and backflow into the pulmonary artery.

This is a rare disorder (1 in 3 million births, less than 0.5% for congenital heart disease).

Symptoms begin at about 2 months and occur simultaneously with pulmonary vascular resistance -> coronary artery removal -> reduction of ischemia

Even in the case of normal echoes, evidence of ECG ischemia and mitral valve regurgitation dilated cardiomyopathy suggests the presence of ALCAPA. [Gonzales, 2015]

Cardiac CT and MRI depict complex anatomical structures and can be used to contribute to surgical planning. [Paragraph 2015, Aruna Mata, 2015]

Unlike other cardiomyopathy in children, ALCAPA-induced ischemic cardiomyopathy may respond to surgical treatment. [Gonzales, 2015]

If it is discovered early and is repaired by surgery, the results are very good and re-intervention is rare. [2015 Cabrera, 2015 Gonzalez]

Let's listen to the hearts of older children! Is there noise that is consistent with MR (actually listening)? We need to follow up and restrict physical activity until you can exclude ALCAPA

Pulmonary artery stenosis (PAS) is congenital or acquired and may develop as a solitary or multiple lesion. Acquired PAS usually occurs after surgical correction of congenital cardiac anomalies such as the cause of left coronary artery anomalies (ALCAPA) and tetrahedral tetrahedral (TOF) due to the pulmonary artery. Important PAS treatment options include stent implantation, balloon angioplasty, and surgery. In an 8 - year - old boy, the left coronary artery was reimplanted directly into the aortic root by median sternotomy under cardiopulmonary bypass. The patient's general condition decreased with signs and symptoms associated with right heart failure during the first 6 hours after surgery. Furthermore, elevation of liver enzyme level and deterioration of renal function

Place the blood vessel at the wide end of the heart. The coronary artery is in that position, the right ventricle is positioned with a finger to position the pulmonary artery, and the aorta is located behind the pulmonary artery. The pulmonary vein is at the top of the left atrium. The superior vena cava is at the top of the right atrium. At first, due to the unfamiliar structure of the heart, the process slowly progressed, and many aspects were uncertain. Furthermore, before the experiment, I found a photograph of the cardiac structure, while comparing the photograph with the actual heart, it made it easy to find the structural position. However, the correct position of the image is different from the actual position of the heart. The reason is that the chart is idealized, that the actual heart is collapsed in the sky, and there is no color contrast to distinguish the structure