CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 8, September 2012
e18
AFRICA
The objective in modern surgery is the formation of two
coronary artery systems to ensure long-term vascular patency,
using native blood vessels in order for the coronary ostia and
coronary arteries to maintain their normal growth potentials. A
few surgical procedures are suggested based on the localisation
of the abnormal coronary artery ostium. One of these is
the ligation of the abnormal coronary artery, combined with
saphenous vein or LIMA graft or re-implantation to the aortic
root either directly or with the help of a pulmonary flap. Another
method, defined by Takeuchi,
10
involves formation of a tunnel
with intra-pulmonary baffle.
Surgical treatment is also required in isolated LAD anomalies,
although the ischaemic area is smaller. Direct implantation of
the abnormal coronary artery to the aorta can be successfully
achieved in the early stages of life; however, this type of surgical
procedure is difficult and involves increased risks in older
patients. Similar surgical procedures can be performed in cases
of isolated LAD anomaly. With early diagnosis and surgical
treatment, this syndrome usually has a good prognosis.
Isolated LAD originating from the pulmonary artery is
extremely rare. The patient had exercised regularly and had
never experienced any previous symptoms. However, cardiac
arrest developed during exercise, he developed ventricular
fibrillation and was defibrillated. The patient was referred to
us for implantable cardioverter defibrillator (ICD) implantation
with an early diagnosis of hypertrophic cardiomyopathy,
Anti-arrhythmia treatment must be considered for patients with
a history of VT/VF (ventricular fibrillation) that is not associated
with an acute ischaemic event. Treatment options include drug
therapy, ICD implantation or catheter ablation. ICD implantation
has been shown to be superior to drug treatment in patients with a
history of VT/VF and previous myocardial infarction (secondary
prophylaxis). ICD implantation may also be considered in
patients without a history of arrhythmias, when there is marked
left ventricular dysfunction, and electrophysiological study
shows inducible VT (primary prophylaxis).
11
In our case, we
implanted an ICD as secondary prophylaxis.
Conclusion
In young patients who survive sudden cardiac arrest, along
with cardiomyopathy and arrhythmic events, coronary artery
anomalies should be considered as a priority in establishing a
diagnosis. If a strong suspicion emerges based on colour Doppler
echocardiography results, the condition should be assessed with
coronary artery or CT angiography.
References
1.
Keith JD. The anomalous origin of the left coronary artery from the
pulmonary artery.
Br Heart J
1959;
21
: 149–161.
2.
Malec E, Zajac A, Mikuta M. Surgical repair of anomalous origin of
the coronary artery from the pulmonary artery in children.
Cardiovasc
Surg
2001;
9
: 292–298.
3.
Barbetakis N, Efstathiou A, Efstathiou N,
et al
.
A long-term survivor of
Bland-White-Garland syndrome with systemic collateral supply: a case
report and review of the literature.
BMC Surg
2005;
5
: 23.
4.
Taylor AJ, Rogan KM, Virmani R. Sudden cardiac death associated
with isolated congenital coronary artery anomalies.
J Am Coll Cardiol
1992;
20
: 640–647.
5.
Derrick MJ, Moreno-Cabral RJ. Anomalous origin of the left anterior
descendingarteryfromthepulmonaryartery.
JCardSurg
1991;
6
:24–28.
6.
Takimura CK, Nakamoto A, Hotta VT,
et al
.
Anomalous origin of the
left coronary artery from the pulmonary artery: Report of an adult case.
Arq Bras Cardiol
2002;
78
: 309–314.
7.
Sanjay T, Apurba KS, Kurur SV. Lessons from a case of anomalous
the left coronary artery from the pulmonary artery.
Ind J Thorac
Cardiovasc Surg
2005;
21
: 171–172.
8.
Ten Kate GJR, Weustink AC, de Feyter PJ. Coronary artery anomalies
detected by MSCT coronary angiography in the adult.
Neth Heart J
2008;
16
: 369–375.
9.
Alexi-Meskishvili V, Berger F, Weng Y,
et al.
Anomalous origin of the
left coronary artery from the pulmonary artery in adults.
J Card Surg
1995;
10
: 309–315.
10.
Takeuchi S, Imamura H, Katsumoto K,
et al.
New surgical method
for repair of anomalous left coronary artery from pulmonary artery.
J
Thorac Cardiovasc Surg
1979;
78
: 7–11
11.
Goldberger Z, Lampert R. Implantable cardioverter-defibrillators:
expanding indications and technologies.
J Am Med Assoc
2006;
295
:
809–818.
