0:01

Anomalous coronary arteries come in various forms.

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This is one of the more dramatic cases.

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So let's take a look at multiple things before

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we zoom on to pathology, which is quite obvious.

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First is, let's look at the contrast pacification.

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You'll notice that the right

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side is unapacified mostly, and

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the left side is nicely pacified.

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Left atrium, left ventricle.

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Left ventricle is enlarged.

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Left atrium is also enlarged.

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And you see these gigantic coronary arteries.

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So why do you have gigantic coronary arteries?

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So coronary artery aneurysm has multiple causes.

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It can be from atherosclerosis, vasculitis, childhood

0:49

cavernous artery disease, but the thing to notice over

0:51

here is that all coronary arteries are aneurysmal,

0:57

dilated, uh, even branched coronary arteries are

1:00

dilated and there is a uniformity to the dilation.

1:04

And you can see that there are tiny in

1:06

relationship to the big arteries, but

1:08

still pretty big the way they exist.

1:11

These are collateral arteries, just all dilated.

1:15

And the issue is that the left coronary artery

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has a connection with the pulmonary artery.

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And see the pulmonary artery gives

1:30

off the left coronary artery.

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It almost looks like the left coronary artery rises

1:33

up the right place where it should, but it's not.

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So you have an arterial system connected

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to a venous system, and as you know,

1:44

that means that there is an AV fistula.

1:47

So whenever there's an AV

1:48

fistula, you have three things.

1:49

You have high output, so you've got chances

1:53

of getting high output cardiac failure,

1:55

because you've got the arterial system

1:58

really just pulsating into the venous system.

2:01

Second thing is you've got a kind of a steal phenomenon

2:06

because now blood is being stolen away from the

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coronary arteries, left ventricle.

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And the third is that the arteries in

2:16

response to the overall demand become larger.

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So this is known as ALKAPA, which is anomalous

2:26

left coronary artery arising from pulmonary

2:27

artery and at least coronary artery dilation,

2:31

and it can lead to ischemia and LV dysfunction.

2:37

Thank you.