The anomaly of birth of the coronary arteries from the pulmonary artery (about 08 cases)

Introduction

Anomaly of birth of the coronary artery from the pulmonary artery (ACAPA) is the most common coronary anomaly. More classic in pediatrics, it is a rare congenital heart disease that is sometimes fatal.

Objective

Share the experience of our service by determining the prevalence, the clinical and paraclinical characteristics as well as the prognosis of the disease.

Methods

This is a retrospective, descriptive study of 08 children with ACAPA followed in the unit of cardio-paediatrics of the cardiac department, Ibn ROCHD Hospital, over a period of 5 years from September 2018 to September 2023.

Results/Expected results

The prevalence of ACAPA compared to the number of congenital heart diseases diagnosed during the same study period: 0.16%.

Distribution:

– 2 ALCAPA, and 6 ARCAPA;

– 5 boys, 3 girls;

– Average age: 1 year 9 months.

The most frequent reason for consultation is a food difficulty with the signs respiratory.

ECG showed in 2 patients a Q wave of necrosis which is a very specific sign of the disease.

TTE: shows indirect signs such as hypokinetic dilated cardiomyopathy which is present in all our patients, valvular leaks are also frequent. Direct signs are less frequent and difficult to objectivise: absence of visualization of the origin of the coronary artery a the base of the aorta, or visualization of the hyper refractile endocardium, with image abnormal birth of a coronary artery.

Cardiac catheterization with angiography is performed in case of diagnostic doubt.

After the positive diagnosis, 5 of our patients underwent surgery, only 1 patient died in the post-operative follow-up, the evolution was favorable for the 4 other patients.

Conclusion/Perspectives

ACAPA is a rare but serious ischemic cardiomyopathy because it involves the patient's vital prognosis. Only early diagnosis and surgery aimed at restoring a dual coronary artery system have excellent results and allow progressive myocardial recovery.