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Abstract:

Aim: was to show capabilities of MDCT-angiography of coronary arteries in the detection and characterization of rare forms of anomalous coronary arteries from the pulmonary artery in adult patients

Materials and methods: we made retrospective study of anomalous coronary arteries from pulmonary arteries in patients who have been examined and operated in our Center for the period of 2008-2013. All patients on admission underwent: echocardiography, selective coronary angiography and MDCT coronarography Postoperatively - echocardiography and MDCT coronarography.

Results: for the period of 5 years about 30,000 patients underwent examination in our center, and congenital anomalous coronary arteries from the pulmonary artery was identified only in 6(0,02 %) cases. 4( 0,013%) of them had «infantile» type - ALCAPA. In adults, anomalous coronary arteries from the pulmonary artery revealed in 2 cases: a 31 year woman had «adult» type ALCAPA (0,003%) and 17-year boy - isolated form ARCAPA (0,003%). Preoperative MDCT provided direct visualization of anomalous coronary arteries from the pulmonary artery, displayed the spatial relationship of coronary vessels in the three-dimensional image that helped to clarify and demonstrate for cardiac surgeons individual characteristics of congenital disorder. Marked dilatation and tortuous course of trunks and branches of coronary arteries, the severity of which declined after surgical correction. Adult patients successfully underwent surgical correction: reimplantation of anomalous coronary arteries in orthotopic position in cardiopulmonary bypass with the creation of two-coronary blood supply of the heart

Conclusions: Even in cases where a definitive diagnosis of anomalous coronary arteries from the pulmonary artery can be diagnosed by echocardiography and coronary angiography, before surgery is recommended to perform MDCT angiography to clarify the anatomy and more specific spatial representation of the topography of the anomalous vessel. In the late postoperative period this method allows to assess in details the condition of coronary flow and effectiveness of coronary intervention. 

 

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