Anomalous origins of a coronary artery from the pulmonary artery: A series of three case reports undetected into adulthood

Introduction: An anomalous origin of the coronary artery from the pulmonary artery (ACAPA) is a rare congenital anomaly resulting in sudden death in 90% of infants during their first year of life. Diagnosis in living adults is particularly unusual, especially for left coronary artery arising from the pulmonary artery (ALCAPA) given the large perfusion distribution that the left system provides to the myocardium. Surgery to correct and restore a bi-coronary arterial circulatory system has historically been the standard of treatment given the lethality of the diagnosis. However, advances in coronary imaging have led to an increased incidence of diagnosis in adulthood and challenges the true association between sudden death and ACAPA. This makes the decision for surgical correction more complex. Case Series: Herein, we presented three cases of coronary anomalies arising from the pulmonary artery that remained undetected until adulthood, only one of which was managed surgically. Conclusion: Currently, the prevalence of ACAPA in adults is low. Hence, there is no strong evidence based recommendations for management of adult patients. With advances in diagnostic modalities and potentially an increase in reported ACAPA cases, more data will become available to helpguide the decision of surgical verses medical management. (This page in not part of the published article.) International Journal of Case Reports and Images, Vol. 6 No. 7, July 2015. ISSN – [0976-3198] Int J Case Rep Images 2015;6(7):391–395. www.ijcasereportsandimages.com Mastoris et al. 391 CASE REPORT OPEN ACCESS Anomalous origins of a coronary artery from the pulmonary artery: A series of three case reports undetected into adulthood Katie L. Mastoris, Ataul Qureshi, Navin K. Subrayappa, Matthew W. Martinez, James Wu