Noriyoshi Kajihara, Toshihide Asou*, and Seiyo Yasui
Department of Cardiovascular Surgery and Pediatric Cardiology, Kanagawa Children’s Medical Center,
2-138-4 Mutsukawa, Minami-ku, Yokohama 232-8555, Japan
* Corresponding author. Tel: þ81 45 711 2351, Fax: þ81 45 721 3324, Email: tasou@kcmc.jp
A 12-month-old girl was admitted to Kanagawa Children’s
anomalous origin of the right coronary artery from the
main pulmonary artery (ARCAPA). The electrocardiogram
(ECG) recorded non-significant findings at rest
but the ST depression from V1 to V3 at her crying.
On the coronary angiography, it looked like a single
coronary artery from the left coronary sinus; however,
this artery was dilated and meandering and linked the
RCA whose flow was retro-perfusion, that is, continuous
flow poured into proximal of the main pulmonary trunk
beside the aortic root, namely, the original site of RCA
(Figure). The operation confirmed the budging and meandering
conus branch of the RCA on the right ventricular
outflow tract and linked the RCA originated from the
main pulmonary trunk to the left anterior descending
artery. Re-implantation was performed using cardiopulmonary
bypass, and the anomalous artery was anastomosed
with the ascending aorta that was hinged with a
J-shaped incision. The postoperative course was excellent.
When last seen, 20 months after the operation,
she was well with no evidence of myocardial ischaemia.
ARCAPA is rare. To the best of our knowledge, it had
been reported that there were only three cases of isolated ARCAPA reported under 2 years of age. The reason is many of these cases were reported
not lethal or asymptomatic, in contrast to the origin of the left coronary artery from the pulmonary artery. However, it has some reported sudden
death ARCAPA cases revealed by autopsy. In our case, ECG demonstrated myocardial ischaemia at the time of her crying.
Figure. Angiography: pre-operative. left coronary arteriography showing the flow of anomalous origin of the right coronary artery from the main
pulmonary artery to the main pulmonary trunk. Collateral artery linked from the left anterior descending artery to the right coronary artery
poured into the main pulmonary trunk. White arrow shows collateral artery and the conus branch of the right coronary artery.
Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org
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