Anomalous origin of the left coronary artery from the pulmonary trunk, also known as Garland-Bland-White syndrome, is an extremely rare but potentially fatal congenital cardiovascular anomaly, and it often exists as an isolated condition. We hereby report an adult female who was admitted for mild chest discomfort and was accidentally diagnosed to have anomalous origin of the left coronary artery from the pulmonary trunk. This anomaly was simply repaired by using a bovine pericardial patch to obliterate the anomalous opening in the pulmonary trunk and a single coronary artery bypass graft. This report highlights the characteristic events of the anomaly in an adult with only mild symptoms.
Anomalous origin of the left coronary artery from the pulmonary trunk, also known as Garland-Bland-White syndrome, is an extremely rare but potentially fatal congenital cardiovascular anomaly, and it often exists as an isolated condition. Some reports have found its association with tetralogy of Fallot (TOF), complete atrioventricular septal defect, and aortopulmonary (AP) window, which arises secondary to failure of septation in the aorticopulmonary trunk [
The patient is a 36-year-old female school teacher who was in her normal state of health until two years prior to the present admission when the patient started to feel occasional pressure-like chest discomfort and palpitation. The patient went to a local hospital for help. Mild mitral regurgitation was told, and the patient was then discharged with medical management as an outpatient. However, one month prior to the present admission, the patient’s chest tightness, although still mild on onset, had increased in frequency. The patient went back to the same hospital for further evaluation. This time, a cardiac catheterization was performed and accidentally revealed anomalous drainage of left coronary artery (LCA), including all its branches (like the left anterior descending artery, left circumflex artery, and the left diagonal artery), into the main pulmonary artery. Single right coronary artery (RCA) originated from the aorta, and mild mitral regurgitation was seen concurrently in the cardiac catheterization. Upon recommendations from the patient’s family, the patient came to our hospital and was admitted for surgical managements.
After the patient was admitted into our service, chest X-ray, ECG, carotid ultrasound, pulmonary function test, pressure volume recording, blood analysis, and viral check were done and all revealed normal findings. No fever, leukocytosis, or any sign that might reveal infectious process had been determined. The patient was clear for surgical correction (Figure
Echocardiographic representation indicating the abnormal opening of the left coronary artery inside the main pulmonary trunk.
The patient received surgery on December 25, 2003 (Christmas Day). The operation consisted of closing the anomalous opening in the pulmonary trunk simply with a commercially available bovine pericardium patch; concurrently, a single coronary artery bypass utilizing the Left Internal Thoracic Artery was made to the patient’s Left Interventricular Artery (left anterior descending artery). The patient tolerated the procedure well. The anastomosed artery was first perfused from both the antegrade and the retrograde aspects. Vessel flow meter was then used to check the blood flow of the anastomosed artery. Good and adequate flows (mean flow: 93.1 mL/min with no insufficiency) revealed on the flow meter data. The patient’s postoperative recovery phase was smooth with no complication occurred. The patient was transferred to the general ward after just four days in the intensive care unit, and she was discharged ten days after the operation (Figure
Illustrated representation of the corrective procedure for the anomalous left coronary artery. A bovine pericardium patch was applied into pulmonary trunk to obliterate the anomalous opening of the left coronary artery, while the left internal thoracic artery was used for the anastomosis to the left anterior descending artery.
Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) was first described by Brook in 1886 [
Anomalous origin of the left coronary artery from the pulmonary trunk, also known as Garland-Bland-White syndrome, is an extremely rare but potentially fatal congenital cardiovascular anomaly. With its high mortality within the first year of life, even fewer infants who were born with this anomaly. Our case was thereby presented not only because of its rarity but also for the mild clinical onset the patient presented, and a simple operation utilizing the well-established and common cardiac procedures can effectively correct this highly fatal defect.