Key result
In a case of ALCARPA, preoperative imaging failed to delineate the intramural course, leading to accidental injury of the left coronary artery during surgical dissection.
Why the study?
Preoperative imaging frequently fails to delineate a potential intramural course of the descending LCA in the aorta in ALCARPA, highlighting the need for vigilance during surgical management.
Case Report (n=1)
Surgeons should maintain high vigilance for an intramural aortic course of the left coronary artery in patients with ALCARPA, as preoperative imaging may fail to delineate it.
Answers are grounded in this paper and cite their sources.
Alerts surgeons to occult intramural LCA course in ALCARPA despite negative imaging; hypothesis-generating for refined preoperative protocols.
Anomalous origin of the left coronary artery (LCA) from the right pulmonary artery (ALCARPA) is an extremely rare subset of an already rare entity, anomalous origin of the LCA from the pulmonary artery. Whenever it is diagnosed preoperatively, one should be extremely vigilant about the potential intramural course of the descending part of the LCA in the aorta. Preoperative imaging frequently fails to delineate this intramural course. We report our experience with one such case where we had accidentally injured the LCA during dissection from the right pulmonary artery. Although it was successfully managed, it reinforces our aforementioned point concerning the importance of vigilance in seeking to identify intramurality as a component of this anomaly of coronary artery origin.
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Agrawal et al. (2019) conducted a case report in Anomalous origin of the left coronary artery from the right pulmonary artery (ALCARPA) (n=1). Surgical dissection of ALCARPA was evaluated. In a case of ALCARPA, preoperative imaging failed to delineate the intramural course, leading to accidental injury of the left coronary artery during surgical dissection.
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