Cardiovascular magnetic resonance findings in repaired anomalous left coronary artery to pulmonary artery connection ALCAPAReport as inadecuate

Cardiovascular magnetic resonance findings in repaired anomalous left coronary artery to pulmonary artery connection ALCAPA - Download this document for free, or read online. Document in PDF available to download.

Journal of Cardiovascular Magnetic Resonance

, 13:27

First Online: 16 May 2011Received: 13 December 2010Accepted: 16 May 2011


BackgroundAnomalous origin of the left coronary artery from the pulmonary artery ALCAPA is a rare coronary artery anomaly. This study shows the role of cardiovascular magnetic resonance CMR in assessing young patients following surgical repair of ALCAPA.

Methods6 patients, aged 9-21 years, with repaired ALCAPA 2 Tackeuchi method, 4 direct re-implantation underwent CMR because of clinical suspicion of myocardial ischemia. Imaging used short and long axis cine images assess ventricular function, late-gadolinium enhancement LGE detect segmental myocardial fibrosis, adenosine stress perfusion detect reversible ischaemia and 3D whole-heart imaging visualize proximal coronary arteries.

ResultsThe left ventricular LV global systolic function was preserved in all patients mean LV ejection fraction = 62.7% ± 4.23%. The LV volumes were within the normal ranges, mean indexed LVEDV = 75.4 ± 3.5 ml-m, LVESV = 31.6 ± 9.4 ml-m. In 1 patient, hypokinesia of the anterior segments was visualized. Five patients showed sub-endocardial LGE involving the basal, antero-lateral wall and the anterior papillary muscle. Three patients had areas of reversible ischemia. In these 3, 3D whole-heart MRA showed that the proximal course of the left coronary artery was occluded confirmed with cardiac catheterisation.

ConclusionsCMR is a good, non-invasive, radiation-free investigation in the post-surgical evaluation of ALCAPA. In referred patients we show that basal, antero-lateral sub-endocardial myocardial fibrosis is a characteristic finding. Furthermore, stress adenosine CMR perfusion, can identify reversible ischemia in this group, and was indicative of left coronary artery occlusion.

Electronic supplementary materialThe online version of this article doi:10.1186-1532-429X-13-27 contains supplementary material, which is available to authorized users.

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Author: Aurelio Secinaro - Hopewell Ntsinjana - Oliver Tann - Pia K Schuler - Vivek Muthurangu - Marina Hughes - Victor Tsang - An


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