A hidden culprit for ventricular dysfunction in aortopulmonary window repair: Anomalous origin of left coronary artery. Case report and review of literature

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Presentation transcript:

A hidden culprit for ventricular dysfunction in aortopulmonary window repair: Anomalous origin of left coronary artery. Case report and review of literature Adnan Alhadlaq, MD, FRCPC, FAAP, Santokh Dhillon, MD, FRCPC, Camille L. Hancock-Friesen, MD, FRCSC, FACS, Arif Hussain, MD The Journal of Thoracic and Cardiovascular Surgery Volume 152, Issue 6, Pages e123-e126 (December 2016) DOI: 10.1016/j.jtcvs.2016.07.055 Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A and B, Preoperative echocardiographic views. A, Subcostal coronal view showing large aortopulmonary window (APW) type I. B, Parasternal short-axis view showing apparent normal origin of the left coronary artery (LCA) from the aorta (Ao, white arrow). C through E, Diagrammatic illustrations of the heart viewed from above showing the anomalous origin (ostium) and course of the left coronary artery (dotted lines) in relation to the surgical repair. C, Preoperative anatomy showing the aortopulmonary window (single red star) with the left coronary artery ostium originating from the left-facing sinus of the pulmonary valve with the left coronary artery coursing adjacent to the left aortic sinus and then to the left posterior to the pulmonary artery (PA) and following the usual course. D, After initial patch (2 red stars) closure of aortopulmonary window leaving the left coronary artery origin from the pulmonary artery. E, Postoperative view after revision of repair and creating a baffle (3 red stars) to incorporate the left coronary artery ostium into the systemic circulation. RV, Right ventricle; RA, right atrium; LA, left atrium; SVC, superior vena cava; Cx, circumflex coronary artery; LAD, left anterior descending coronary artery; RCA, right coronary artery. The Journal of Thoracic and Cardiovascular Surgery 2016 152, e123-e126DOI: (10.1016/j.jtcvs.2016.07.055) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Two-dimensional echocardiography falsely suggesting normal origin of left coronary artery. The Journal of Thoracic and Cardiovascular Surgery 2016 152, e123-e126DOI: (10.1016/j.jtcvs.2016.07.055) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Video 1 A.H. explaining the importance of the association of anomalous origin of the left main coronary artery from a pulmonary artery with aortopulmonary window and how this case report highlights issues pertaining to perioperative management and planning. Video available at: http://www.jtcvsonline.org/article/S0022-5223(16)30875-3/addons. The Journal of Thoracic and Cardiovascular Surgery 2016 152, e123-e126DOI: (10.1016/j.jtcvs.2016.07.055) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions