Comparative Analysis of Coronary Artery Anomalies Originating From the Pulmonary Artery: Clinical Presentation, Imaging Findings, and Surgical Outcomes in Diverse Age Groups.

BACKGROUND & AIM: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), a rare congenital heart defect, shows progression closely tied to patient age and the development of coronary artery collateral circulation. Understanding of this condition is largely derived from case reports and remains limited. This study aims to thoroughly investigate the differential manifestations of ALCAPA across various age groups, with a central emphasis on the evaluation of the coronary collateral circulation system, thereby contributing to a more nuanced approach in the clinical management of ALCAPA. This study aimed to explore the differences in imaging characteristics and clinical presentations of ALCAPA among different age groups.

METHOD: We conducted a retrospective analysis in 255,875 consecutive patients who underwent coronary computed tomographic angiography (CCTA) between 2006 and 2022, identifying 34 cases of ALCAPA. Patients were divided into Group A (≤1 year old, n=14) and Group B (>1 year old, children and adults, n=20). CCTA was used to assess coronary artery anomalies, complemented by echocardiography, chest radiographs, electrocardiograms, and comprehensive evaluation of clinical features and cardiac function.

RESULTS: Group A exhibited more severe symptoms, including dyspnoea, feeding difficulties, and cyanosis, alongside higher rates of cardiac murmurs, electrocardiogram abnormalities, cardiothoracic ratio, and detected coronary ostial stenosis than those in Group B (all p<0.05). Group B, however, presented with a more complex collateral circulation, predominantly composed of epicardial and septal collaterals, rated CC2 with significant tortuosity (p<0.05). Postoperative left ventricular function significantly improved in Group A (p<0.05), whereas no substantial change was observed in Group B (p=0.118).

CONCLUSIONS: Age is crucial in determining the clinical presentation and therapeutic responsiveness in ALCAPA, with infants aged ≤1 year showing poor development of epicardial and septal collaterals and more severe symptoms, and benefiting from early surgical intervention to restore dual coronary artery circulation.