|Association of Significant Mitral Regurgitation and Left Ventricular Dysfunction with ALCAPA (Anomalous origin of the left coronary artery from the pulmonary artery) Syndrome in A Young Patient|
|Reza Hajizadeh1, Abdolmohammad Ranjbar1, Samad Ghaffari1, Rezayat Parvizi1, Mehrnoush ToufanTabrizi1, Bahram Sohrabi1|
|1Department of Cardiology,and Cardiovascular Surgery, Cardiovascular Research Center,Tabriz University of Medical Sciences,Tabriz,Iran|
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A 18-year-old female was referred with progressive exertional dyspnea and palpitation since two years ago. She came with dyspnea function class III. On physical examination a pansystolic murmur of grade III/VI was detected in left sternal border. Her blood pressure was 100/70 and she had sinus tachycardia (Heart rate=110). Transthoracicechocardiography showed moderateto severe mitral regurgitation,mildly reducedleft ventricular ejection fraction (LVEF = 45%–50%) andturbulent jet in color doppler study across ventricular septum.Because of low LVEF and dyspnea aortography was done for patient which typi¬cally showed a large right coronary artery (RCA) but left coronary ostium was not found in the left aortic sinus. During the late phase of the angiography, left anterior descending(LAD) and left circumflex (LCX)arteries filled retrogradely by collateral circulation from the RCA branches,and in later sequences, retrograde flow from the LAD and LCx arteries opacified the left main coronary artery (LMCA) and the main pulmonary artery(Figure 1). Hence, coronary angiography confirmed the diagnosis of ALCAPA syndrome and reimplantation of the left main coronary artery into ascending aorta was done for patient, also mitral valve was repaired. Immediately after operation, the symptoms of patient relieved and after seven days coronary angiography confirmed the patency of the left main coronary artery (Figure 2).The study protocol was approved by the institutional ethics committee of Tabriz University of medical sciences. The patient provided written informed consents for participation.
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