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Chapter-20 Congenital Coronary Artery Anomalies

BOOK TITLE: Clinical Diagnosis of Congenital Heart Disease

Author
1. Mishra BR
2. Bahuleyan CG
3. Garg Naveen
ISBN
9788184481617
DOI
10.5005/jp/books/10126_20
Edition
1/e
Publishing Year
2008
Pages
14
Author Affiliations
1. Max Diagnostics, Cuttack, Odisha, India
2. Trivendrum Medical College, Trivendrum, Cardiovascular Center, Ananthapuri Hospitals and Research Institute, Thiruvananthapuram, Kerala, India, Cardiovascular Center, Ananthapuri Hospitals and Research Institute, Trivandrum, Kerala, India, Cardiovascular Centre, Ananthapuri Hospitals and Research Institute, Thiruvananthapuram, Kerala, India, Government Medical College, Thiruvananthapuram, Kerala, India
3. Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, Noninvasive Cardiac Lab, Indraprastha Apollo Hospitals, New Delhi, India, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, BK Hospital Faridabad, Haryana, India, Badshah Khan Government Hospital Faridabad, Haryana, India, Noninvasive Cardiac Lab Indraprastha Apollo Hospitals, New Delhi, India, Indraprastha Apollo Hospital, New Delhi, India, BK Hospital, Faridabad, Haryana, India, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, Lucknow, UP, S.G.P.G.I.M.S., Raebareli Road, Lucknow, Uttar Pradesh, India, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, U.P., India, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow
Chapter keywords

Abstract

Coronary artery anomalies is important because any abnormal course may be life threatening particularly during or after surgical repair. When there is a direct communication between coronary artery and a cardiac chamber or with pulmonary artery the clinical condition is known as congenital coronary arteriovenous fistula. Coronary fistula takes origin from right coronary artery in 60 percent and from left coronary in 40 percent of cases. In 90 percent of cases, these abnormal coronaries terminate in a right-sided chamber. Majority of cases are asymptomatic. A superficial continuous murmur is audible whose site and nature varies according to the chamber it terminates. Echo identifies the dilated and tortuous proximal coronary artery and demonstrate the site of entry of the fistula. When left coronary artery (LCA) arises from the pulmonary artery and then runs a normal course, it is known as anomalous left main coronary artery arising from the pulmonary artery (ALCAPA) or Bland-White-Garland syndrome. Blood flows from right coronary artery through anastomotic channels to LCA and then to pulmonary artery (PA). Majority with ALCAPA are critically ill and almost all of them die in the first year of life secondary to severe congestive heart failure. ECG shows myocardial ischemia/infarction in LCA territory. Echocardiography demonstrates an abnormal origin of LCA from PA with retrograde flow from LCA to PA. Cardiac catheterization and coronary angiography remains the gold standard for diagnosis of coronary arterial anomalies. Surgery is the definite treatment of such defects.

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