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J Thorac Cardiovasc Surg 2006;131:911-912
© 2006 The American Association for Thoracic Surgery

Brief Communication

Anomalous left coronary artery arising from the left pulmonary artery, aortic coarctation, and a large ventricular septal defect

John Santosh Kumar Murala, MBBS, MS, MCh a , Steven Cooper, MBChB, FRACP b , Barry Duffy, AM, MBBS, FRACP, FJFICH c , Nizam Matbah, MBBCh, MMED b , Elizabeth Argent, MBBS, FRACP d , Graham Nunn, MBBS (Hon), FRACS, AM a , *

a Department of Cardiothoracic Surgery of Sydney Children's Hospital, Randwick, New South Wales, Australia.
b Department of Paediatric Cardiology of Sydney Children's Hospital, Randwick, New South Wales, Australia.
c Department of Children's Intensive Care of Sydney Children's Hospital, Randwick, New South Wales, Australia.
d Department of General Paediatrics of Sydney Children's Hospital, Randwick, New South Wales, Australia.

Received for publication October 2, 2005; accepted for publication October 18, 2005.

* Address for reprints: Graham Nunn, MBBS (Hon), FRACS, AM, Department of Cardiothoracic Surgery, Sydney Children's Hospital, High Street, Randwick, New South Wales, Australia 2031. (Email: gnunn@tpg.com.au).

The first 20% of the full text of this article appears below.

We describe a case of large ventricular septal defect (VSD), coarctation of the aorta, anomalous left coronary artery arising from the left pulmonary artery (ALCALPA), and congenital diaphragmatic hernia that was successfully managed surgically. Literature search revealed no report of a similar condition.

Clinical Summary

A baby girl was found to have a right-sided diaphragmatic hernia antenatally. Fetal cardiac ultrasonography suggested perimembranous VSD. These diagnoses were confirmed postnatally, and the hernia was repaired. In addition to the VSD, the baby was found to have an aortic coarctation and pulmonary hypertension (PHT) out of proportion to the size of the VSD. Medical treatment failed to control symptoms of respiratory distress, and surgical intervention to repair the VSD and coarctation was planned. Preoperative cardiac catheterization was performed to assess PHT and to confirm the severity of the coarctation. This confirmed a large perimembranous VSD with large left-to-right shunt and balanced ventricular pressures, moderate coarctation of the aorta with isthmic . . . [Full Text of this Article]






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