Cardiovascular magnetic resonance findings in repaired anomalous left coronary artery to pulmonary artery connection (ALCAPA)

Background: anomalous origin of the left coronary artery from the pulmonary artery (alcapa) is a rare coronary artery anomaly. this study shows the role of cardiovascular magnetic resonance (cmr) in assessing young patients following surgical repair of alcapa. methods. 6 patients,aged 9-21 years,with repaired alcapa (2 tackeuchi method,4 direct re-implantation) underwent cmr because of clinical suspicion of myocardial ischemia. imaging used short and long axis cine images (assess ventricular function),late-gadolinium enhancement (lge) (detect segmental myocardial fibrosis),adenosine stress perfusion (detect reversible ischaemia) and 3d whole-heart imaging (visualize proximal coronary arteries). results: the left ventricular (lv) global systolic function was preserved in all patients (mean lv ejection fraction = 62.7% 4.23%). the lv volumes were within the normal ranges,(mean indexed lvedv = 75.4 3.5 ml/m 2,lvesv = 31.6 9.4 ml/m 2). in 1 patient,hypokinesia of the anterior segments was visualized. five patients showed sub-endocardial lge involving the basal,antero-lateral wall and the anterior papillary muscle. three patients had areas of reversible ischemia. in these 3,3d whole-heart mra showed that the proximal course of the left coronary artery was occluded (confirmed with cardiac catheterisation). conclusions: cmr is a good,non-invasive,radiation-free investigation in the post-surgical evaluation of alcapa. in referred patients we show that basal,antero-lateral sub-endocardial myocardial fibrosis is a characteristic finding. furthermore,stress adenosine cmr perfusion,can identify reversible ischemia in this group,and was indicative of left coronary artery occlusion. © 2011 secinaro et al; licensee biomed central ltd.