Abnormal discharge of the left coronary artery from the pulmonary artery: symptoms, diagnosis, treatment

Anomalous divergence of the left coronary artery from the pulmonary artery is 0.22% of all congenital heart defects. The left coronary artery departs from the left, less often from the right sinus of the pulmonary artery, its further course and branchings are the same as in the norm. In the case of pronounced intercoronary anastomoses, it is expanded and tortured. The mouth of the right coronary artery is in the right coronary sinus of the aorta. A wide network of anastomoses is visible on the anterior surface of the heart. With a sufficient number of anastomoses, clinical signs of malformation appear later, often in the second decade of life; with insufficient anastomoses, and consequently, with insufficient blood supply to the myocardium, signs of a defect are detected early, sometimes even during the period of the newborn. Isolate the infantile and adult type of abnormal retraction of the left coronary artery. Myocardial ischemia may be secondary to low perfusion pressure as a result of blood flow through the collaterals from the right to the left coronary artery, and then into the pulmonary artery. In the expressed "syndrome of stealing," subendocardial blood flow is particularly affected. This is one of the reasons for the development of a secondary fibroelastosis of the endo- and myocardium for a given defect.

Symptoms of abnormal departure of the left coronary artery from the pulmonary artery can manifest at any age. The first signs: a violation of the general condition, lethargy, sweating. Half of patients may have seizures of sudden anxiety, dyspnea. Against this background, an increase in body temperature may occur, the appearance of a loose stool (has a reflex, like in angina and myocardial infarction, character). Many children in the stage of decompensation lag behind in physical development, the left-sided heart hump develops early. The apical impulse is diffuse, weakened. The boundaries of relative cardiac dullness are widened mainly to the left. Tones of the heart are muffled, systolic noise can be heard. Heart failure develops to a greater extent in the left ventricular type. As follows from the above, by the nature of complaints and clinical signs suspected anomalous deviation of the left coronary artery from the pulmonary artery is quite difficult, so the diagnosis is based on sufficiently specific results of instrumental examination.

An abnormal departure of the left coronary artery from the pulmonary artery can for the first time be suspected in the ECG. Detect a pronounced deviation of the electrical axis of the heart to the left, deep Q tooth (more than 4 mm or more 1/4 of its R) in I, aVL and left thoracic leads (maximum in lead aVL). In the same leads (especially important in leads I and aVL), a negative tine T is detected . If there are insufficient intercoronary anastomoses, ECG displays signs of a previous myocardial infarction.

When radiographing chest organs, cardiomegaly is detected mainly at the expense of the left divisions.

In echocardiographic studies, dilatation of the left ventricle cavity with signs of hypokinesia, increased echogenicity of the papillary muscles. When studying the root of the aorta, a normally departing right coronary artery and a lack of a left coronary artery are found. Anomalous coronary artery separation is often accompanied by mitral regurgitation.

Cardiac catheterization and angiocardiography are performed to exclude other coronary anomalies and defects.

Treatment of abnormal divergence of the left coronary artery from the pulmonary artery

There is no specific drug treatment. With signs of heart failure, appropriate drug therapy is indicated. Operative treatment is carried out at the earliest possible time. The operation of choice is a direct reimplantation of the left coronary artery into the aorta, as a result of which the system of two coronary arteries is restored.

[1], [2], [3], [4]