0:00

Case number 21 is is going

0:03

to be shown. It's going to skip case number 25

0:06

in the interest of time. We do have adequate cases to

0:09

fill the hour. This is case number 21

0:12

and it belongs to a

0:16

a relatively younger patient. I think

0:19

this patient was aged a nine years old and presented with heart failure

0:22

and chest pain based on these two images. These

0:25

are CTA images. I think you're recognized that this

0:28

is a CTE this two-seater

0:31

reconstructions here.

0:33

But this abnormality may also be shown by MRI we can discuss

0:36

MRI in a minute and the role of MRI in this example, but

0:39

these two pictures belong to cetery constructions

0:42

of a

0:44

young girl who presented a chest pain shortness of breath and

0:47

the correct diagnosis. The first question based on these would be we have

0:50

the polling question. Please enormous left train from

0:53

the right sinus enormous right coronary from the left sinus coronary

0:56

artery fistula and almost left coronary artery than

0:59

pulmonary artery coronary arteriovenous malformation.

1:02

The correct answer will be one of these five.

1:06

Okay, good. Excellent. Very educated audience. Yeah and almost

1:09

left main coronary artery than pulmonary artery as you can see the left

1:12

coronary arteries arising from the pulmonary artery here the right

1:16

coronary artery rises from the right sinus whereas the

1:19

left is not present from the left sinus rises from the pulmonary artery. So what's

1:22

known as Al Capa a LC APA a normal stuffed

1:25

cronary artery from the pulmonary artery and the

1:28

in the subsequent questions, we're going to discuss the physiology and

1:31

that the correction of this disease Al Capa anomalous

1:34

left coronary arteries and pulmonary artery. It's a dangerous malignant to

1:37

normally if not treated the consequences can

1:41

be heart failure shunting mitral insufficiency, Mike

1:44

Holland functional around its function because of fish came

1:47

here. Let's go to the second question pertaining to

1:50

this case. This is a patient.

1:52

Which of the following is a non-malignant coronary anomalies?

1:55

So coronome is a broadly classified into malignant and non-malignment malignant

1:58

if they can cause sudden death or associated with

2:01

severe symptoms and heart failure

2:04

death and non malignant if they're innocuous sub

2:07

inanimalities.

2:09

So one of these is a non-managementality.

2:13

Um, unfortunately the correct answer the analysis is not right. The correct

2:16

answer is 5 anomalous circumflex on the right sinus of the

2:19

Retro iot goes into arterial courses are malignant if they

2:22

left arises from the right side. So the right arise from the left Tenison passes

2:25

between the uterine the pulmonary artery such a vessel can

2:28

be can be can be compressed or compromised the Lumina be

2:31

compromise as it passes between the Iota and the pulmonary artery

2:34

and it's known some malignant to normally whereas if a if

2:37

a vessel which rises from the opposite sinus has a retro

2:40

aortic cause that implies passing behind the your chain

2:43

front of the left atrium. That's a non malignant. Normally Al

2:46

Capa is a malignant to normally the enormous

2:49

left clone realizes from the pulmonary artery. Next question

2:52

will pertain to the physiological discuss. The clinical implications of

2:55

el Cape coronary artery fistula is a malignant normally

2:58

but a coronary artery which arise from the opposite

3:01

sinus and has a retro aortic cause and non

3:04

interior, of course is not a magnet to normally.

3:07

Can we go to case number? I'm going to the last question pertaining

3:10

to this case, please.

3:11

Okay, all the following statements regarding Al Capa True

3:14

except there is one false statement here and I'd

3:17

like for the audience to just spend a minute might have to leave this

3:20

question up and allow the audience to

3:22

To think a little bit.

3:24

So there is one false statement here.

3:27

But therefore true statements. Can we pick out the phone statement?

3:31

Okay, that's a true statement the correct answers actually number four

3:34

the normally costs cause a

3:37

right to left extra cardiac shunt notice. This shunt here is

3:40

from the right from the aorta.

3:42

Through the right coronary artery Across The myocardium and collateral

3:45

vessels into the left ground reality the pulmonary artery the

3:48

two coronary arteries are connected by anastomos in the surface of the heart.

3:51

The one crony in the right arises from a from

3:54

the aorta and the left Horizons from a low pressure circulation of

3:57

the pulmonary artery in this case and because of anastomosis between

4:00

the two coronary arteries blood blood flow growth

4:03

goes from the aorta right coronary artery across the collaterals into

4:06

the left corner in the pulmonary artery. You can see the splash

4:09

here this blush on the CT indicates that indicates a

4:12

direction of the shunt from the left coronary into the

4:15

primary artery the fact the blood into the left corner

4:18

is coming from the Yota. So it's tailing blood from The myocardium aorta

4:21

right coronary artery myocardial surface

4:24

interminecartile vessels left corner

4:27

artery into the pulmonary artery. It creates an extra cardiac

4:30

left to right shunt and because of that

4:33

shunt a lot of the physiology and the clinical consequences ensure. There's

4:36

there's mine cartilage came here because of deshunt into

4:39

the primary artery from the aorta. It's a

4:42

consequences of my college gaming Michael infection muscle that's

4:45

function can occur heart failure can

4:48

eventually ensure so it's an extra cardiac left to

4:51

right.

4:51

Not a right to left turn but they left to right shunt from

4:54

the Yoda into the pulmonary artery across the coronary

4:57

arteries and the collaterals. The other answers are

5:00

correct. If we can just have that all again, please the other

5:04

answers are typically presents in a neonates with heart

5:07

failure and they dilated cardiomyopathy marginal insufficiency

5:10

can occur because of mitral valve

5:13

dysfunction from infarction property muscles can be echogenic on

5:16

echogeography because of infarction chest pain

5:19

and my college came here recognize the presentations because

5:22

of my current steel and blood bling stolen Across The

5:25

myocardium

5:26

The correct answer is number four normally comes

5:29

in extra cardiac right to left shunt and the preferred

5:32

treatment in newborn in infants consists of transferring the coronary artery

5:35

on the left along with the button of

5:38

tissue into the left sinus. So the

5:41

coronary switch or currently button transfer is a

5:44

preferred technique of choice for treatment of an El

5:47

Capa abnormality. Okay. I think

5:51

this this is the third question pertaining to this case.