Bax, J.J.

Dijkman, P.R.M. van

Fortuni, F.

Kuneman, J.H.

Leiden University Scholary Publications

Anomalous origin of the left coronary artery from the pulmonaryartery in a 72-year-old patientKuneman, J.H.; Fortuni, F.; Dijkman, P.R.M. van; Bax, J.J.CitationKuneman, J. H., Fortuni, F., Dijkman, P. R. M. van, & Bax, J. J. (2020). Anomalous origin ofthe left coronary artery from the pulmonary artery in a 72-year-old patient. EuropeanHeart Journal, 41(43), 4213-4213. doi:10.1093/eurheartj/ehaa514 Version: Publisher's VersionLicense: Creative Commons CC BY 4.0 licenseDownloaded from: https://hdl.handle.net/1887/3232627 Note: To cite this publication please use the final published version (if applicable).CARDIOVASCULAR FLASHLIGHT doi:10.1093/eurheartj/ehaa514Online publish-ahead-of-print 3 August 2020....................................................................................................................................................Anomalous origin of the left coronary artery from the pulmonary arteryin a 72-year-old patientJurrien H. Kuneman 1†, Federico Fortuni 1,2†, Paul R.M. van Dijkman1, and Jeroen J. Bax 1*1Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2300RC, The Netherlands; and 2Department of Molecular Medicine, Unit ofCardiology, University of Pavia, via Forlanini, Pavia 27100, Italy*Corresponding author. Tel: 131 71 526 2020, Fax: 1 31 71 526 6809, Email: j.j.bax@lumc.nl*†The first two authors are co-first authors.A 72-year-old female with atypicalchest pain was referred to ourcentre for evaluation. She has nocardiac history or any cardiac riskfactors besides prior to smoking.Transthoracic echocardiographyshowed concentric hypertrophy ofthe left ventricle (LV) with mildlyreduced LV ejection fraction (47%).Colour Doppler imaging demon-strated anomalous flow at the rightventricular (RV) apex (white arrow,Panel A, Supplementary materialonline, Video).Coronary computed tomographyangiography was performed for fur-ther evaluation. An anomalous coro-nary anatomy was demonstratedwith the left coronary artery (LCA)originating from the pulmonaryartery (PA) (yellow arrow, Panels Band C). Numerous collateral vessels(green arrow, Panel C) arose from anextremely ectatic right coronaryartery (RCA) emptying into the LCAresulting in a left-to-right shunt atthe PA (asterisk, Panel C). Moreover,the abnormal echocardiographicfindings were clarified as contrastmedia emerged at the apex of theRV indicating the presence of fistulae between RCA–LCA and RV (white arrow, Panel B). Anomalous origin of the left main coronary arteryfrom the pulmonary artery or adult Bland–White–Garland syndrome is a rare congenital condition. It is the most common cause of myo-cardial dysfunction in infancy and during adulthood may result in heart failure, mitral regurgitation, and ventricular arrhythmia.Nevertheless, in this case, a unique collateral circulation allowed long-term survival without remarkable cardiac symptoms or complications.Coronary computed tomography angiography permits accurate and non-invasive depiction of coronary artery anomalies.Ao, aorta; LA, left atrium; LV, left ventricle; PA, pulmonary artery; RA, right atrium; RCA, right coronary artery; RV, right ventricle.Supplementary material is available at European Heart Journal online.Published on behalf of the European Society of Cardiology. All rights reserved. VC The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.Cardiovascular flashlight 4213Downloaded from https://academic.oup.com/eurheartj/article/41/43/4213/5879864 by Jacob Heeren user on 11 January 2023

Anomalous origin of the left coronary artery from the pulmonary artery in a 72-year-old patient

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