The prevalence, characteristics and outcomes of anomalous left coronary artery from the pulmonary artery at the Chris Hani Baragwanath Academic Hospital over a 28-year period

Chhiba , Anjali-Larisha
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Background Anomalous left coronary artery from the pulmonary artery (ALCAPA) accounts for 0.25-0.5% of congenital cardiac disease. ALCAPA results in myocardial ischaemia and a dilated cardiomyopathy which can be reversed post-surgical correction. We describe the presenting clinical features, diagnostic findings and post-operative outcomes, including the improvement of the left ventricular function, in patients presenting to a Southern African tertiary care centre. Methods A retrospective analysis of patients with ALCAPA over a 28-year period at the Chris Hani Baragwanath Academic Hospital (CHBAH). Results A total of 38 patients (24 (63.2%) females; median age at diagnosis of 4.6 months (IQR: 3.2 to 9.1 months)) were included. The symptoms and clinical features on presentation were nonspecific. Cardiomegaly on chest X-ray (CXR) was present in 84.2% of patients. Deep Q waves in leads I and aVL was the most prevalent finding on electrocardiography. ST segment depression and T wave inversion occurred in the lateral and inferior diaphragmatic leads. LVEF significantly improved from (38.8±6.3)% to (57.5±9.1)% post-surgical correction (p-value=0.0004) by the first follow up (at a median of 1.3 months). The early mortality rate was 21.6%. Conclusion The symptoms at presentation are nonspecific and predominantly respiratory. A high index of suspicion by clinicians with a focus on the common electrocardiographic features is crucial in the diagnosis of ALCAPA.
A research report submitted in partial fulfilment of the requirements for the degree of Master of Medicine in Paediatrics to the Faculty of Health Sciences, School of Clinical Medicine, University of Witwatersrand, Johannesburg, 2022