CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 5, June 2012
AFRICA
e13
whether it originates from the pulmonary artery or not. A dilated
left coronary artery and a wide right coronary artery observed
on echocardiography should be the first cause of suspicion.
A definite diagnosis is determined with angiography. Passing
contrast through the left coronary artery that originates from
the aorta and observing the passage of contrast through the
collaterals to the right coronary artery and finally into the
pulmonary artery is diagnostic.
7
As can be seen in the literature, medical treatment was given
to a few patients in whom clinical follow up was not done.
14
Usually surgical treatment is suggested, even in asymptomatic
patients. In the literature it is reported that 87% of patients
diagnosed early had surgical treatment.
3
Besides the less-
traumatic simple proximal ligation of the abnormal coronary
artery, in order to remove pulmonary steal, separating the
abnormal artery from the pulmonary artery and re-implanting it
into the aorta is the appropriate surgical procedure.
Surgical treatment is important for two reasons: first, providing
two coronary systems with antegrade flow, re-implanting the
aberrant artery into the aorta decreases the risk of sudden
cardiac death, and second, it removes the risk of pulmonary
steal phenomenon.
15
In their comprehensive study, Radke
et
al
.
3
reported the postoperative follow up of nine patients who
had surgical intervention: there had been regression in the left
coronary artery dilatation after surgical correction. It was also
reported that symptoms and ischaemia did not disappear in two
patients with a dilated left coronary artery and slow peripheral
flow.
Conclusion
Although medical treatment is an option in an abnormal right
coronary artery (different from ALCAPA where re-implantation
into the aorta of the aberrant artery is obligatory), surgical
correction of the anatomy is strongly supported by
physiopathological findings.
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