Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)

Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)

:cupid: In this condition, the left coronary comes off the pulmonary artery, while
the right continues to come off normally from the anterior aortic sinus.
:point_right: In the fetus , myocardial perfusion is normal.
:point_right:Soon after birth, however, the pulmonary artery pressure falls, perfusion pressure to the left coronary artery (LCA) becomes inadequate; myocardial ischemia, infarction, and fibrosis result.
:point_right: In some cases, interarterial collateral anastomoses develop between the right coronary artery (RCA) and LCA. Blood flow in the LCA is then reversed, and it empties into the pulmonary artery, , a condition known as the “myocardial steal”.
:point_right:This results in ischemia of the
:fire:(anterolateral ):fire:wall of the LV.
:point_right:The left ventricle becomes dilated, and its performance is decreased. Mitral insufficiency is afrequent complication

:broken_heart:Infants present at 2 weeks to 6 months of age with heart failure from Ml or ischemia. Poor feeding, tachypnea
and respiratory symptoms are most common, although some have episodes of restlessness/crying, as though in pain.

:heartpulse:Cardiomegaly is prominent, ECG shows :fire:(anterolateral):fire: infarct pattern with abnormal Q waves in I, aVL, and the left anterior chest leads (V5 and V6); additionally, ST and T wave changes often occur.
:point_right:Echo is often diagnostic, but occasionally cardiac catheterization is required.

:yellow_heart: Untreated, death often occurs from heart failure within the 1st 6 mo of life.
:gift_heart: Those who survive require reconnecting the aberrant coronary artery to the aorta.

Nelson 21, Medstudy pediatrics 2018