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Anomalous origin of the left coronary artery from the pulmonary trunk, also known as Garland-Bland-White syndrome, is an extremely rare but potentially fatal congenital cardiovascular anomaly, and it often exists as an isolated condition. We hereby report an adult female who was admitted for mild chest discomfort and was accidentally diagnosed to have anomalous origin of the left coronary artery from the pulmonary trunk. This anomaly was simply repaired by using a bovine pericardial patch to obliterate the anomalous opening in the pulmonary trunk and a single coronary artery bypass graft. This report highlights the characteristic events of the anomaly in an adult with only mild symptoms. [ABSTRACT FROM AUTHOR]

A 16-year-old girl was referred to our hospital to perform cardiac multi-slice computed tomography (MSCT) due to an unclear view of coronary arteries in echocardiography performed during a routine visit to the cardiology clinic. As an infant she was hospitalized due to signs of severe heart failure, and while in hospital she underwent cardiac arrest. However, ever since this incident she has not experienced any cardiovascular symptoms, and still remains asymptomatic. On physical examination we found systolic murmur localized to the left sternal border. In echocardiography the dimensions of cardiac chambers and ventricular contractility were normal. Cardiac MSCT demonstrated markedly dilated tortuous right coronary artery (RCA), giving very well-developed collaterals crossing the interventricular septum toward the left coronary artery (LCA). The LCA was also dilated but not as much as the RCA. The images showed an anomalous origin of the LCA from the pulmonary artery trunk (ALCAPA) and suggested retrograde filling of the LCA through collaterals from the RCA and emptying into the pulmonary artery trunk (PA). Coronary angiography and aortography confirmed the diagnosis of ALCAPA (Bland-White-Garland syndrome). It showed a very big tortuous RCA, the LCA filling retrogradely through collaterals from the RCA and draining into the PA. Anomalous left coronary artery from pulmonary artery is a congenital anomaly associated with early infant mortality, very rarely diagnosed in asymptomatic adults, with uncertain but probably poor prognosis. MSCT is useful for diagnosis. The patient still remains asymptomatic and so far she and her parents have not agreed to surgical treatment. [ABSTRACT FROM AUTHOR]

79-year-old woman with Bland-White-Garland syndrome was admitted to our institution for surgical treatment of severe mitral regurgitation (MR). She had previously undergone mitral valve repair and coronary artery bypass grafting for both mitral insufficiency and a coronary artery anomaly 14 years earlier. However, the degree of residual MR had gradually worsened, and redo mitral valve surgery was scheduled. Multidetector row computed tomography revealed that the right coronary artery (RCA) was dilated and located just behind the sternum, and saphenous vein graft bypassed to the left anterior descending artery was occluded. This meant that the RCA was the only vessel supplying coronary blood flow. We successfully performed port-access mitral valve replacement under mild hypothermia with fibrillatory arrest to prevent damage to the RCA. We propose that port-access surgery is a safe and effective treatment for redo cardiac surgery after initial surgical correction of a congenital heart anomaly. [ABSTRACT FROM AUTHOR]

Anomalous origin of the left coronary artery from pulmonary artery is a rare congenital heart anomaly. It presents predominantly in infancy with clinical features of myocardial ischemia and/or congestive heart failure. It poses a clinical diagnostic challenge to family physicians and pediatricians as it may present in a way similar to common pediatric conditions such as infantile colic, food intolerance, gastroesophageal reflux, and bronchiolitis. Awareness of this condition is essential for prompt diagnosis and referral to a cardiac center for early surgical intervention and improved prognosis. This article reviews this rare but serious disease in children. [ABSTRACT FROM AUTHOR]

Untreated ALCAPA cases most often die in infancy. Adults with untreated ALCAPA commonly present with mitral regurgitation, severe left ventricular dysfunction, and sometimes myocardial infarction. Herein, we present an asymptomatic adult female with ALCAPA recognized through cardiac computed tomography (CT). In ALCAPA, like other coronary anomalies, cardiac CT is often instrumental in providing unique noninvasive and clinically relevant evaluation. Herein, we present an atypical presentation of an asymptomatic middle-aged adult female with ALCAPA. [ABSTRACT FROM AUTHOR]

We experienced two adult cases of anomalous origin of the left coronary artery from the pulmonary artery, so-called Bland–White–Garland (BWG) syndrome, that presented with ventricular tachycardia (VT) and ventricular fibrillation during exertion in daily life. They presented to our hospital with syncope due to VT, and recovered following application of an automated external defibrillator with cardiopulmonary resuscitation. We diagnosed BWG syndrome by multi-detector computed tomography angiography and coronary angiography. We analyzed the mechanisms of lethal arrhythmias in relation to myocardial ischemia on exertion. Coronary flow modification and implantable cardioverter defibrillator implantation were performed in order to prevent future lethal arrhythmia due to myocardial ischemia. It is important to be aware of congenital heart disease in ordinary cases. < Learning objective: We experienced two rare cases of patients who were admitted with ventricular tachycardia and ventricular fibrillation who had adult type Bland–White–Garland syndrome during exertion in daily life. It is important to be aware of congenital heart disease in ordinary cases.> [ABSTRACT FROM AUTHOR]

Anomalous left coronary artery from the pulmonary artery (ALCAPA) in adults is a rare congenital coronary abnormality. We report a case of ALCAPA in a 73-year-old female managed by total arterial revascularization. doi: 10.1111/jocs.12755 (J Card Surg 2016;31:380-382). [ABSTRACT FROM AUTHOR]

The article reports on the results of the first whole exome sequencing (WES) of an anomalous origin of left coronary artery from pulmonary artery (ALCAPA) or Bland-White-Garland syndrome in a 36-year-old athlete who was admitted to the SANKO Hospital in Gaziantep, Turkey. It cites the coexistence of mutations in CFTR, MEN1 and PKP2 in an ALCAPA case and the need for innovative molecular diagnostics and broadly framed multiomics integrative biology studies of ALCAPA in the future.

The article informs about evaluation of a Point-of-care testing (POCT) for counting white blood cells and differentials among older patients with acute diseases. Topics include HemoCue WBC DIFF System being a battery-operated portable POCT device that counts white blood cells (WBCs) and the differentials easily; and how HemoCue captures photomicroscopic images in blood of a microcuvette, which generates the counts of total WBCs and differentials of neutrophils, lymphocytes, and basophils.

Objective: Results of the repair of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) have improved. Direct implantation of the anomalous coronary artery into the ascending aorta establishes a dual-coronary system and is the goal of current surgical approaches. We report the development of our surgical technique for ALCAPA. Methods: Between September 1993 and December 2000, 13 patients underwent surgery for ALCAPA. There were four males and nine females. Ages ranged from 1 month to 25 years (median=3.9) and weight ranged from 2.6 to 102 kg (median=16.8). One patient had previously undergone an operative procedure at an outside institution. Results: Direct implantation of the anomalous coronary artery into the ascending aorta was feasible in 12 of 13 patients. In situ transfer was performed in one patient with an intramural coronary artery. The first case in the series required an intrapulmonary baffle reconstruction (Takeuchi procedure) because the coronary artery arose remotely from the ascending aorta from the left-anterior sinus of the PA. For coronary transfer, a trapdoor flap was created on the ascending aorta for the implantation of the coronary button and the sinus defect in the main PA was augmented with a pericardial patch. The left ventricular (LV) shortening fraction was improved from a median value of 27% (range 12–36%) preoperatively to 33% (range 24–45%) in the immediate postoperative period (P=0.004). The LV end-diastolic dimension decreased from a median value of 36 mm (range 22–70 mm) preoperatively to 29 mm (range 19–56 mm) in the immediate postoperative period (P=0.004). There has been no mortality or reoperation during a median follow-up of 36 months. Conclusions: Using a standard technique, direct implantation of the anomalous coronary artery into the ascending aorta was achieved in all cases but one. At intermediate follow-up, LV function had improved by echocardiography. No postoperative mechanical circulatory support was required in any of these patients. This operative technique is reproducible and is applicable to the majority of patients with ALCAPA. [Copyright &y& Elsevier]

The article offers information on a 23 year old male patient who was diagnosed with severely impaired left ventricular function with anterior hypokinesia and Bland-White-Garland syndrome using a coronary angiography.

Background: Anomalous coronary artery from the pulmonary artery is a rare congenital disorder with high mortality rates in infancy. Adult cases can present with life-threatening arrhythmias and sudden cardiac death., Case Summary: We report three cases of adults with anomalous pulmonary origin of each of the main coronary branches. The first patient with an anomalous left coronary artery from the pulmonary artery presented with an out-of-hospital cardiac arrest. The second patient with an anomalous circumflex artery from the pulmonary artery was evaluated for a bicuspid aortic valve and a suspected coronary fistula but was otherwise asymptomatic. The third patient with an anomalous right coronary artery from the pulmonary artery presented with anginal symptoms. In all cases, the diagnosis was made by cardiac computed tomography or coronary angiography. Cardiac magnetic resonance imaging was performed in all patients to guide clinical decision making on surgical or non-invasive management. All patients underwent surgical repair. In two patients, a dual coronary artery system was restored by aortic reimplantation of the anomalous coronary artery. In one patient, aortic reimplantation was unsuccessful due to poor vessel quality and the anomalous coronary artery was ligated. Clinical follow-up during 1.8-9.7 years did not show any cardiovascular complications and all patients are currently alive and asymptomatic., Discussion: Anomalous coronary artery from the pulmonary artery can have various clinical presentations in adulthood. Cardiac magnetic resonance imaging is a useful modality to guide selection of patients who might have symptomatic or prognostic benefit from surgical repair., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Coronary artery stenosis is a rare phenomenon in children. Coronary stent implantation is generally not considered a standard treatment option due to technical difficulties and potential complications in this group of patients. Nevertheless, several pediatric cases reporting successful implantation with acceptable short-term experiences have been described. The following case presents a successful stent implantation for left main coronary artery (LMCA) stenosis early after surgery for anomalous left coronary artery from pulmonary artery (ALCAPA) at the age of 6 months. The excellent mid-term results and notably the procedure's potential as a long- term treatment in small children are highlighted. A 6-month-old infant underwent surgery for ALCAPA. Due to sudden postoperative deterioration, cardiac catheterization was performed. Coronary angiography revealed severe (90%) ostial LMCA stenosis. A PROMUS drug-eluting stent (Promus Element AL3.0 x 8 mm, Boston Scientific, Natick, Massachusetts, USA) was implanted. The procedure was performed without complications. Antiplatelet therapy with acetylsalicylic acid and clopidogrel was initiated. Subsequently, cardiac function improved slowly. Cardiac catheterization 3 years 8 months after stent implantation showed no restenosis with a proximal LMCA diameter still at the 50th percentile for age. Neither were signs of heart failure reported at the last follow-up at 7 years of age. Presupposing normal growth, the implanted stent would thus provide sufficient myocardial perfusion with a LMCA lumen at the 40th percentile at the age of 16 years. In selected cases, coronary stent implantation may be an effective mid- to long-term treatment of coronary artery stenosis even in very young children. [ABSTRACT FROM AUTHOR]

The Grajcarek Unit of the Pieniny Klippen Belt (PKB), at the boundary between the Central (Inner) and Outer Carpathians, resulted from the convergence of the ALCAPA (the Alps–Carpathians–Pannonia) block and European plate. The strongly deformed slices of the Grajcarek Unit consist of Jurassic–Cretaceous sedimentary rocks associated with Late Cretaceous–Middle Palaeocene synorogenic wild-flysch, and sedimentary breccias with olistoliths. Maximum burial temperatures and burial depths were estimated based on vitrinite reflectance data. The vitrinite reflectance values were wide scattered through the Grajcarek sedimentary succession, especially in the flysch formations. This is attributed mainly to the depositional effects that affected the vitrinite evolution. The determined maximum burial temperatures were interpreted due to the regional compression controlled by tectonic burial coeval with thrusting and strike-slip faulting. The regional vitrinite reflectance variations might estimate cumulative displacement around the NNW–SSE and oriented the strike-slip Dunajec fault, which is a continuation of the deep fracture Kraków–Myszków fault zone. [ABSTRACT FROM AUTHOR]

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We report herein an adult case of anomalous origin of the left coronary artery from the pulmonary artery (Bland-White-Garland syndrome; BWG syndrome). The patient had chest discomfort during exercise and signs of mitral regurgitation. We diagnosed him as having BWG syndrome by angiography, and performed surgical treatment. At the operation, retrograde coronary blood flow was found through the left coronary artery during aortic crossclamping. This suggested extracardiac anastomosis from peripheral arteries to the left coronary artery. Since the collateral blood flow was considerable during aortic cross-clamping, only the left coronary artery was closed. A collateral from the left bronchial artery to the left circumflex artery was demonstrated by postoperative angiography. Cases of adults with BWG syndrome are rare, and this may be the first report of a collateral from the bronchial artery. [ABSTRACT FROM AUTHOR]

The anomalous origin of the left coronary artery arising from the pulmonary artery (ALCAPA), also known as Bland-White-Garland (BWG) syndrome, is a rare congenital heart disease. We present cases of three children in whom BWG syndrome was repaired surgically. In two of them, the left coronary artery was transplanted from the pulmonary trunk to the aorta, and in one, the Takeuchi procedure was performed. In both cases in which the left coronary artery was transplanted to the aorta, mechanical circulatory support was used after the surgery. This was due to a low ejection fraction (10%) while weaning from cardiopulmonary bypass. Although associated with numerous complications, mechanical circulatory support can be a lifesaving therapy in patients with a poor left ventricular function after the correction of BWG syndrome. [ABSTRACT FROM AUTHOR]

Abstract: Anomalous origin of the left coronary artery from the pulmonary artery is rare but causes myocardial ischemia and sudden death. A few patients with this anomaly can survive to adulthood without sufficient collateral coronary flow or surgical intervention. We present here a case of acute inferior myocardial infarction, which may occur due to thrombotic occlusion of the right coronary artery, in a 63-year-old woman with anomalous origin of the left coronary artery from the pulmonary artery, providing specific coronary angiographic findings. [Copyright &y& Elsevier]

In the current manuscript, we report an unusual case of a young 18‐year‐old woman who survived an out‐of‐hospital cardiac arrest secondary to Bland‐White‐Garland syndrome. Her transthoracic echocardiogram showed an abnormal color Doppler flow‐pattern within the myocardium indicative of coronary fistulous flow that prompted further evaluation with coronary CT angiography, which confirmed the diagnosis. Our case serves not only as a reminder to consider coronary artery anomalies as a cause of sudden cardiac death in young individuals but also as a prompt to investigate unusual echocardiographic findings with alternative imaging when the diagnosis may not be initially clear. [ABSTRACT FROM AUTHOR]

Within-plate migration of alkaline basaltic centers is generally related to translation of the lithosphere with a hot spot above a largely stationary mantle plume. Here, we report, for the first time, a hitherto unrecognized migration of small-sized Late Miocene to Early Quaternary alkali-basaltic volcanic centers at the transition from Eastern Alps to Pannonian Basin. The volcanic centers migrated along the South Burgenland High in a regular sequence over a 95 km distance from NNE to SSW between 11 Ma and 1.7 Ma. The basaltic magmatism was also associated with thinning of the crust and lithosphere and an increase of the thermal gradient. In detail, three stages of migration are recognized as follows: (i) Stage 1 with a 55 km SSW-towards shift of volcanism between 11 and 5 Ma; (ii) Stage 2 with a ~ 35 km-WSW shift and enlargement of the distribution of volcanic centers between ca. 5 and 3.5 Ma; and (iii) Stage 3 with a S-directed shift of ca. 25 km between 3.5 and 1.7 Ma. The Stage 1 shift of alkali-basaltic volcanism can be also observed in the Little Hungarian Plain and South Slovakia–Nógrád volcanic fields, and the Stage 2 in the Balaton-Bakony of the Pannonian Basin (north of Lake Balaton). We propose that this pattern and mechanism of migration of the volcanic centers along the South Burgenland High resulted from thermally induced progressive thinning of the lithosphere over a mantle plume underneath the ALCAPA block, which was moving from SSW to the NNE between 11 and 1.7 Ma. The migration was interrupted by a marked eastward shift between 5 and 3.5 Ma (Stage 2). The migration of volcanic centers correlates with orientation and timing of regional shortening phases and inversion of the Alpine-Carpathian-Pannonian system although the overall amount of shortening remains uncertain. The deformation events allow to correlate Adria motion with deformation along the frontal parts of Eastern Alps, and Western and Eastern Carpathians across the western Pannonian Basin. • Alkaline basalt centers allow trace motion of ALCAPA block between 11 and 2 Ma. • Trace of eruption centers is subparallel with late-stage inversion of the Alpine-Pannonian system. • Lithospheric thinning of the orogenic back-arc system is associated with alkali-basalts. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 32-year-old man showing no medical history was admitted due to out-of-hospital cardiac arrest while playing football. He was treated with bystander cardiopulmonary resuscitation. His ECG showed no symptoms of cardiac disease but later diagnosed that the arrest was due to ALCAPA or Bland– White–Garland syndrome.

Background: Evidence for peritoneal dialysis catheter (PDC) usage in pediatric patients undergoing surgery for deteriorating cardiac dysfunction is lacking. This investigation explored factors associated with PDC usage and its effectiveness in children with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA)., Methods: Eighty-four children undergoing left coronary artery transfer were retrospectively recruited. The primary endpoint was the postoperative ratio of the general ward/[intensive care unit (ICU)] length of stay. Univariable and multivariable analyses were fitted to assess factors related most strongly to PDC and the ratio of general ward/ICU length of stay., Results: Of the 84 patients, 17 (20.2%) underwent postoperative PDC placement. Patients with extreme cardiac dysfunction [left ventricular ejection fraction (LVEF) ≤25%] were much more likely to require a PDC (OR, 9.88; 95% CI, 2.13-45.76; P = 0.003). Moreover, univariate analysis indicated that concomitant mitral repair significantly decreased the likelihood of PDC placement (OR, 0.25; 95% CI, 0.07-0.85; P = 0.026). In those with cardiac dysfunction (LVEF ≤50%), PDC use was associated with a reduced ratio of ward/ICU length of stay (B, - 1.62; 95% CI, - 2.77- -0.46; P = 0.008), as was age ≤ 12 months (B, - 1.57; 95% CI, - 2.88- -0.26; P = 0.02). At the 1-year follow-up, cardiac improvement was significantly greater in patients with PDC usage than in those without it (P <  0.001), and the number of mitral recoveries was comparable between the groups (64.2% vs. 53.3%, P = 0.434)., Conclusion: In cohorts with ALCAPA, PDC placement following surgery may be necessary for patients with extreme cardiac compromise, while concomitant mitral repair can probably reduce their usage rate. PDC is beneficial in conferring an improvement in cardiac and mitral performance. Importantly, after patients are transferred from the ICU, recovery efficiency in the general ward can be enhanced by PDC placement, and hospital discharge can therefore be achieved early, especially for patients younger than 12 months or with LVEF ≤50%., (© 2021. The Author(s).)