Anomalous left coronary artery from the right pulmonary artery with an intramural course

Krishnan Ganapathy Subramaniam; Dhruva Sharma; Vishal Vinayak Bhende; Vikram Kudumula; Shrinath N Reddy

doi:10.4103/jpcs.jpcs_12_22

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CASE REPORT

Year : 2022 | Volume : 8 | Issue : 1 | Page : 59-61

Anomalous left coronary artery from the right pulmonary artery with an intramural course

Krishnan Ganapathy Subramaniam¹, Dhruva Sharma², Vishal Vinayak Bhende³, Vikram Kudumula⁴, Shrinath N Reddy¹
¹ Sri Padmavathi Children Heart Centre, Tirupati, Andhra Pradesh, India
² Department of Cardiothoracic and Vascular Surgery, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India
³ Consultant Congenital and Paediatric Cardiac Surgeon, Bhanubhai and Madhuben Patel Cardiac Centre, Bhaikaka University, Karamsad, Anand, Gujrat, India
⁴ Department of Paediatric Cardiology, Children's Brain and Heart Institute, Andhra Hospitals, Vijayawada, Andhra Pradesh, India

Correspondence Address:
Dhruva Sharma
Department of Cardiothoracic and Vascular Surgery, SMS Medical College and Attached Hospitals, J L N Marg, Jaipur - 302 001 Rajasthan
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jpcs.jpcs_12_22

Anomalous left coronary artery from the right pulmonary artery (RPA) is a rare congenital coronary anomaly and is one of the surgically treatable causes of ventricular dysfunction in infants. The left coronary artery when it arises from the RPA or near its base tends to follow the intramural course. Careful echocardiographic evaluation of the course of the coronary artery is necessary under sedation to avoid missing this anomaly. Unroofing of this coronary artery and closing of the pulmonary artery origin are recommended for treatment. We report a case where the intramural course was retrocommissural and unroofing would have resulted in aortic incompetence. We describe how a 90° rotation is possible by augmenting the coronary button with an anterior pericardial hood. The reconstruction of the RPA should be done with adequate mobilization and redundancy to prevent compression and bowstringing of the reimplanted coronary artery.

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