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Cardiovascular magnetic resonance assessment in previously repaired ALCAPA


Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare coronary artery anomaly.

Purpose: The aim of this study is to show the role of cardiovascular magnetic resonance (CMR) in assessing these patients.


6 patients with repaired ALCAPA (2 Tackeuchi, 4 direct re-implantation) underwent CMR to assess clinical suspicion of myocardial ischemia - short axis and long axis cine images (assess ventricular function), late-gadolinium enhancement (detect myocardial fibrosis), adenosine stress perfusion scan (detection of reversible ischaemia) and 3D whole-heart imaging (visualization of proximal coronary arteries).


The LV function was preserved in all patients (mean LVEF= 62.7% ± 4.23%). The LV volumes were within the normal ranges LV (mean indexed LVEDV=75.4 ml ± 3.5, mean LVESV= 31.6 ml ± 9.37) In one patient, hypokinesia of the anterior segments was visualized. 5 of the 6 patients showed sub-endocardial late gadolinium enhancement involving the antero-lateral wall and the anterior papillary muscle. 4 of the 6 patients presented areas of inducible ischemia, reversible at rest. In 3 of the 6 patients the proximal course of the left coronary artery wasn't clearly visualized. In these patients, proximal the LCA obstruction was confirmed during invasive coronary angiography.


CMR is a good, non-invasive, radiation-free investigation in the post-surgical evaluation of ALCAPA. We show that antero-lateral sub-endocardial myocardial fibrosis is a characteristic finding. Furthermore, stress adensoine CMR perfusion, can identify reversible ischaemia in this group. Such imaging may be a promising tool in the future clinical decision -making.

Figure 1
figure 1

The charachteristic LGE in our repaired ALCAPA population .

Figure 2
figure 2

Perfusion defect in repaired ALCAPA.

Figure 3
figure 3

3D whole-heart imaging of ALCAPA repair compared with invasive coronary angiography(Tackeuchi technique)

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This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Secinaro, A., Ntsinjana, H., Muthurangu, V. et al. Cardiovascular magnetic resonance assessment in previously repaired ALCAPA. J Cardiovasc Magn Reson 13 (Suppl 1), P192 (2011).

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