PDF(Pubmed)
Abstract：
Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital malformation. We present a case of an elderly patient with ALCAPA presenting with complete heart block and non-ST-elevation myocardial infarction years after diagnosis and surgical correction. An 81-year-old female with a history of ALCAPA presented to the emergency department with chest pain and progressive mental deterioration. She was bradycardic and hypotensive. An electrocardiogram revealed a complete heart block. Troponin was 4.04 ng/mL. She received atropine and underwent transcutaneous pacing. Left heart catheterization revealed complete occlusion of the mid-left circumflex artery, which was intervened with balloon angioplasty and chronic total occlusion of the right coronary artery. She was supported with temporary transvenous pacing, did not require further pacing support, and was discharged home. Previous records unearthed that in 1988 she had presented with syncope and was diagnosed with ALCAPA, filling from right-to-left collaterals with large and ectatic coronaries. At the time, she underwent surgical correction with excision of the left coronary from the pulmonary artery and reimplantation in the left coronary cusp along the posterior aorta. She had remained asymptomatic after her surgery until this presentation. ALCAPA is extremely rare in adults. Insufficient collaterals to the left ventricle cause inadequate blood supply, leading to ischemia in adults, predisposing them to arrhythmias and risk of sudden death. Adults with ALCAPA remain at increased risk of adverse cardiac events later in life, requiring long-term monitoring.
摘要：
左冠状动脉异常起源于肺动脉（ALCAPA）是一种罕见的先天性畸形。我们介绍了一例患有ALCAPA的老年患者，在诊断和手术矫正后数年表现为完全心脏传导阻滞和非ST段抬高型心肌梗死。一名有ALCAPA病史的81岁女性因胸痛和进行性精神恶化而被送往急诊科。她是心动过缓和低血压。心电图显示完整的心脏传导阻滞。肌钙蛋白为4.04ng/mL。她接受了阿托品并接受了经皮起搏。左心导管检查显示左回旋中动脉完全闭塞，采用球囊血管成形术和右冠状动脉慢性完全闭塞进行干预。她得到了临时经静脉起搏的支持,不需要进一步的起搏支持，出院回家了.以前的记录显示，她在1988年出现晕厥并被诊断出患有ALCAPA，从右到左的侧支充盈着大而扩张的冠状动脉。当时,她接受了手术矫正，从肺动脉切除左冠状动脉，并沿后主动脉植入左冠状动脉尖。她在手术后一直无症状，直到出现这种情况。ALCAPA在成年人中极为罕见。左心室的络脉不足会导致血液供应不足，导致成人缺血，易患心律失常和猝死的风险。患有ALCAPA的成年人在以后的生活中，不良心脏事件的风险仍然增加。需要长期监测。
