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Int J Cardiovasc Imaging (2014) 30:241243 DOI 10.1007/s10554-013-0334-3
CASE-IN-POINT
Coronary CTA appearance of anomalous left coronary artery arising from the pulmonary artery with Intramural Aortic Route
Kevin Day Ryan Avery Isabel Oliva
Clinton Jokerst
Received: 9 November 2013 / Accepted: 18 November 2013 / Published online: 30 November 2013 Springer Science+Business Media Dordrecht 2013
Abstract Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare anomaly in which the left main coronary artery (LM) typically arises from the left infero-lateral aspect of the main pulmonary artery just above the pulmonary valve. This case report presents a case of variant ALCAPA where the LM arises from the supero-medial aspect of the distal pulmonary artery, taking an unusual course within the wall of the aorta: ALCAPA with Intramural Aortic Route (ALCAPA-IAR). Both Coronary artery Computed Tomographic Angiography (CCTA) and digital subtraction angiography were used to image the patient prior to surgical intervention. ALCAPAIAR was conrmed and repaired in the operating room. While this variant has been described in the literature, the appearance on CCTA has not yet been described. Recognizing this variant on preoperative imaging is vitally important as it can affect the surgical approach.
Keywords ALCAPA Intramural Coronary artery
anomaly Coronary artery CT angiography
Introduction
Surgical management of ALCAPA-IAR can differ from the typical form of ALCAPA as the former may be amenable
to coronary artery un-roong [1] while the latter typically requires coronary artery re-implantation. Distinguishing these two entities is important so that the proper surgical approach can be planned. CCTA has emerged as a viable option for imaging coronary artery anomalies [2]. We present a case of ALCAPA-IAR where the anomalous artery was not...