What are the possible complications of anomalous left coronary artery from the pulmonary artery (ALCAPA)?

Updated: Aug 10, 2020
  • Author: Mary C Mancini, MD, PhD, MMM; Chief Editor: Syamasundar Rao Patnana, MD  more...
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Complications are rare. The need for future valve surgery depends on the occurrence of hemodynamic complications (eg, residual mitral valve insufficiency precipitated by permanent damage of the mitral valve architecture) following surgery.

Late complications related to coronary artery insufficiency are more likely to occur if revascularization was accomplished by any of the following:

  • Surgical ligation

  • Bypass grafts that may become occluded or stenotic

  • Intrapulmonary tunnel technique, which may cause supravalvar pulmonary stenosis or, less commonly, become obstructed at the surgically created aortopulmonary window

Inadequate growth of the coronary anastomosis is possible, although unlikely, if surgical reimplantation of the left coronary artery was performed. This occurrence is similar to the rare reports of late coronary artery problems following the arterial switch procedure for transposition of the great vessels that also requires direct coronary transfer and reimplantation.

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