This Cardiac CT exam had been performed on a LightSpeed VCT XT (GE Healthcare) using the cardiac mode with retrospective ECG-gating.

This image displays a fusion between 3D Volume Rendering & 2D view demonstrating the origin of the Left Coronary Artery from the Pulmonary Artery (in blue). The Right Coronary Artery is normal (red).

Following the scan exam, the patient underwent a surgical procedure which consisted in a transposition of the left coronary artery (LCA) on the right coronary artery (RCA) by a venous bypass and also a bypass graft from the Left Internal Mammary artery (LIMA) on the Left Anterior Descending artery (LAD) and Left Marginal Branch (LMB).

The surgical setup had been monitored by a new Cardiac CT exam that showed a good patency of the bypass grafts without postoperative complication.

About the clinical site and the author

Jean-Louis Sablayrolles is a radiologist at the Centre Cardiologique du Nord, or CCN, at Saint Denis, just at the north of Paris, where he is the Head of the Radiology department (CT Scan and MRI) since 1988.

The CCN is a clinic founded by a group of cardiologists in 1973 at Saint Denis specialized in the treatment of cardiovascular diseases.

With over 180 beds, the CCN carries out over 1000 cardiac operations a year and is considered as an excellence center in the diagnosis and treatment of cardiac diseases in France. The Radiology Department is performing Cardiac CT exams since March 2000, acquired a LightSpeed VCT in December 2004 and a LightSpeed VCT-XT configuration in October 2006. More than 6000 Cardiac CT exams were performed since 2004.

The anomalous origin of Left Coronary Artery from Pulmonary Trunk, also known as the Bland-White-Garland syndrome, is one of the most serious congenital anomalies of coronary arteries (0.4% of cardiac abnormalities). The symptoms often appear in infancy. Almost 90% of untreated infants die in their first year.

This anomaly had been unintentionally discovered during a coronary angiogram after a positive stress test. The coronary angiogram had shown an anomalous origin of the left coronary artery originating very probably from the pulmonary artery.
In order to have additional information, a cardiac CT exam is performed before the surgical procedure.

The Cardiac CT exam confirms that the common trunk of the left coronary artery originates at the pulmonary artery. The ostium is located at the proximal and anterior part of the right pulmonary artery, and the common trunk, which is flattened and compressed (especially in systole) is routed between the pulmonary artery and the aorta before continuing on the usual course.