Anomalous Origin of Left Coronary Artery from Pulmonary Artery:A sudden death 16 years after simple ligation of aberrant left coronary artery Shinji Fukuchi 1 , Toshinori Takanashi 1 , Masahiro Endo 2 , Hisae Hayashi 2 , Kenji Nakamura 3 , Michiaki Hiroe 4 1Department of Pediatric Cardiovascular Surgery, Tokyo Women's Medical College, the Heart Institute of Japan 2Department of Cardiovascular Surgery, Tokyo Women's Medical College, the Heart Institute of Japan 3Department of Cardiology, Tokyo Women's Medical College, the Heart Institute of Japan 4Department of Radiology, Tokyo Women's Medical College, the Heart Institute of Japan pp.97-102
Published Date 1986/1/15
DOI https://doi.org/10.11477/mf.1404204810
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The case of a 53 year-old man with anomalous origin of the left coronary artery from the pulmo-nary artery, who had undergone simple ligation of the aberrant vessel was reported. This patient was asymptomatic and doing well under normal life for 16 years after ligation, but he died suddenly while jogging. Three months before his death he was checked through non-invasive examinations in our hospital.

The cardiac size on roentgenogram of the chest remained almost the same as it was in the pre-operative, coronary steal stage. The tomoechocar-diogram disclosed the dilated right coronary artery and prolapsing mitral leaflets. Abnormalities which persisted on ECG at rest were recorded in the last examinations. On treadmill exercise test, ECG didn't show any ischemic changes and sporadic PVCs disappeared at a heart rate over 140 beats/ min. The thallium 201 emission computed tomogram at exercise revealed permanent perfusion defects at anteroapical and lateral regions of the left ventricle without redistribution pattern by supine ergometer.

Postmortem specimen showed the right coronary artery arising from the aorta and the anomalous left coronary artery from the pulmonary artery. Myocardial infarction was found at the anteroapical and lateral region of the left ventricle. The mitral leaflets degenerated with the fibrous thickness and prolapsing. The high risk of sudden death in asymptomatic adult patients with this anomaly had resulted in prompt surgical treatment in literatures. If it is true, the simple ligation method in our case assumed not to prevent the death of arrhythmia in the post-operative periods. Further studies of this anomaly are needed, in order to determine the benefits of the surgical procedures which influenced the differences between the natural history and post-operative prognosis of adult patients with this condition.

Copyright © 1986, Igaku-Shoin Ltd. All rights reserved.


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