[Main Trunk Interposition for Adult Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery Using a Great Saphenous Vein:Report of a Case].

Abstract

A 54-year-old woman was incidentally diagnosed with anomalous origin of the left coronary artery from the pulmonary artery( ALCAPA) during a pre-treatment screening computed tomography( CT) scan for alopecia areata. She had no cardiac symptoms, but cardiac magnetic resonance imaging( MRI) revealed late gadolinium enhancement (LGE) in the mid-anterior wall of the left ventricle, indicating myocardial ischemia. Median sternotomy was performed, with the left main trunk (LMT) was transected from the main pulmonary artery. Initially, reconstruction with an expanded polytetrafluoroethylene(ePTFE) graft was attempted, but the fragility of the vessel wall led to a change in strategy. A saphenous vein graft( SVG) was interposed between the aorta and LMT. The defect in the pulmonary artery was reconstructed with a bovine pericardial patch. Postoperative progress was favorable. Coronary CT during the one-year follow-up confirmed patency of the SVG and suggested regression of collateral circulation, indicating improved perfusion through the newly established graft.