Skip to main content
SpringerLink
Log in

Bland-White-Garland syndrome of anomalous left coronary artery arising from the pulmonary artery (ALCAPA): a historical review

  • Historical Perspective
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

The landmark 1933 case report from Massachusetts General Hospital by Bland, White and Garland (Am Heart J 8:787–801) described a 3-month-old child with progressive feeding problems, cardiomegaly on chest radiography, and EKG evidence of left ventricular damage. Of interest was the fact that the vigilant father of the infant was Aubrey Hampton, a radiologist and future chairman of radiology at Massachusetts General Hospital. At autopsy, the left coronary artery originated from the pulmonary artery rather than from the aorta. Effective treatment for this condition was not available until 1960 when Sabiston, Neill and Taussig showed that the blood flowed from the left coronary artery toward the pulmonary artery. The anomalous left coronary artery was ligated at its junction with the pulmonary artery and the child survived. This historical review of Bland-White-Garland syndrome, now known as anomalous left coronary artery arising from the pulmonary artery (ALCAPA), stresses the continued diagnostic significance of cardiomegaly on chest radiography and EKG changes suggesting left ventricular damage in 2- to 3-month-old infants with feeding intolerance or irritability. With a high index of suspicion, an echocardiogram can be obtained to confirm the diagnosis. Modern surgical methods involve left coronary artery translocation and afford excellent outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Kim SY, Seo JB, Do KH et al (2006) Coronary artery anomalies: classification and ECG-gated multi-detector row CT findings with angiographic correlation. Radiographics 26:317–333

    Article  PubMed  Google Scholar 

  2. Abrikossoff A (1911) Aneurysma des linken herzventrikels mit abnormer abgangsstelle der linken koronararterie von der pulmonalis bei einem funfmonatlichen kinde. Arch Pathol Anat (Paris) 203:413–420

    Article  Google Scholar 

  3. Bland EF, White PD, Garland J (1933) Congenital anomalies of the coronary arteries: report of an unusual case associated with cardiac hypertrophy. Am Heart J 8:787–801

    Article  Google Scholar 

  4. Girish R (2006) Images in cardiology. Multislice cardiac computed tomographic images of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). Heart 92:2

    Article  PubMed  CAS  Google Scholar 

  5. Schwerzmann M, Salehian O, Elliot T et al (2004) Anomalous origin of the left coronary artery from the main pulmonary artery in adults: coronary collateralization at its best. Circulation 110:e511–e513

    Article  PubMed  Google Scholar 

  6. Khanna A, Torigian DA, Ferrari VA et al (2005) Anomalous origin of the left coronary artery from the pulmonary artery in adulthood on CT and MRI. AJR 185:326–329

    PubMed  Google Scholar 

  7. Friedlich AL (1990) Profiles in cardiology. Edward F. Bland. Clin Cardiol 13:513–515

    Article  PubMed  CAS  Google Scholar 

  8. Brooks SJ (1886) Two cases of abnormal coronary artery of the heart arising from the pulmonary artery: with some remarks upon the effect of this anomaly in producing cirsoid dilation of the vessels. J Anat Physiol 20:26–32

    Google Scholar 

  9. Gray SW, Skandalakis JE (1974) The coronary vessels. In: Gray SW, Skandalakis JE (eds) Embryology for surgeons – the embryological basis for the treatment of congenital defects. Saunders, Philadelphia, pp 795–808

    Google Scholar 

  10. Williams IA, Gersony WM, Hellenbrand WE (2006) Anomalous right coronary artery arising from the pulmonary artery: a report of 7 cases and a review of the literature. Am Heart J 152:1004.e9–1004.e17

    Article  Google Scholar 

  11. Gersony WM, Rosenbaum MS (2002) Congenital anomalies of the coronary circulation. In: Gersony WM, Rosenbaum MS (eds) Congenital heart disease in the adult. McGraw-Hill, New York, pp 125–141

    Google Scholar 

  12. Frescura C, Basso C, Thiene G et al (1998) Anomalous origin of coronary arteries and risk of sudden death: a study based on an autopsy population of congenital heart disease. Hum Pathol 29:689–695

    Article  PubMed  CAS  Google Scholar 

  13. Taylor AJ, Rogan KM, Virmani R (1992) Sudden cardiac death associated with isolated congenital coronary artery anomalies. J Am Coll Cardiol 20:640–647

    Article  PubMed  CAS  Google Scholar 

  14. Sabiston DC, Neill CA, Taussig HB (1960) The direction of blood flow in anomalous left coronary artery arising from the pulmonary artery. Circulation 22:591–597

    PubMed  Google Scholar 

  15. Dodge-Khatami A, Mavroudis C, Backer CL (2002) Anomalous origin of the left coronary artery from the pulmonary artery: collective review of surgical therapy. Ann Thorac Surg 74:946–955

    Article  PubMed  Google Scholar 

  16. Reul RM, Cooley DA, Hallman GL et al (2002) Surgical treatment of coronary artery anomalies: report of a 37 1/2-year experience at the Texas Heart Institute. Tex Heart Inst J 29:299–307

    PubMed  Google Scholar 

  17. Cooley DA, Hallman GL, Bloodwell RD (1966) Definitive surgical treatment of anomalous origin of left coronary artery from pulmonary artery: indications and results. J Thorac Cardiovasc Surg 52:798–808

    PubMed  CAS  Google Scholar 

  18. Neches WH, Mathews RA, Park SC et al (1974) Anomalous origin of the left coronary artery from the pulmonary artery. A new method of surgical repair. Circulation 50:582–587

    PubMed  CAS  Google Scholar 

  19. Takeuchi S, Imamura H, Katsumoto K et al (1979) New surgical method for repair of anomalous left coronary artery from pulmonary artery. J Thorac Cardiovasc Surg 78:7–11

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pediatric Surgery,Columbia University College of Physicians and Surgeons, The Morgan Stanley Children’s Hospital of New York-Presbyterian, 3959 Broadway, CHN 216B, New York, NY, 10032, USA

    Robert A. Cowles

  2. Department of Pediatric Radiology, Columbia University College of Physicians and Surgeons, The Morgan Stanley Children’s Hospital of New York-Presbyterian, New York, NY, USA

    Walter E. Berdon

Authors
  1. Robert A. Cowles
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Walter E. Berdon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert A. Cowles.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cowles, R.A., Berdon, W.E. Bland-White-Garland syndrome of anomalous left coronary artery arising from the pulmonary artery (ALCAPA): a historical review. Pediatr Radiol 37, 890–895 (2007). https://doi.org/10.1007/s00247-007-0544-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-007-0544-8

Keywords

Search

Navigation