Teaching Points
Hemitruncus Arteriosus is a rare congenital anomaly in which one of the branch pulmonary artery arises from ascending aorta and the other is continuation of MPA.
Combination of HA with ALCAPA from RPA is extremely rare. The usual clinical presentation of ALCAPA is myocardial ischemia and severe left ventricular dysfunction due to coronary steal. But in this case as the anomalous left coronary artery received blood at aortic pressure from RPA which was arising from ascending aorta, there were no signs of LV dysfunction. Hence it is a physiologically correct ALCAPA.
Anomalous coronary artery origin should always be defined by CT or MR imaging in case of HA, as such complex scenario changes surgical approach and surgical outcome.
References
- Kutsche LM and Van mierop LH. Anomalous origin of pulmonary artery from ascending aorta: associated anomalies and pathogenesis. Am J Cardiol 1988; 61:850-856.
- Sachin Talwar, Palleti Rajashekar et al. Hemitruncus, septal defect and anomalous coronary artery from pulmonary artery – Asian cardiovascular & thoracic Annals – 2012; 21(3):338-341.