{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:35:10Z","timestamp":1787841310194,"version":"build-2784847793"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:p>Congenital coronary artery anomalies as a whole are uncommon. Abnormal origin of the left coronary artery from the pulmonary artery (ALCAPA) is probably the most common congenital coronary defect. An overwhelming majority of the patients with untreated ALCAPA do not survive to adulthood. As yet, there is no consensus on the management of adults with ALCAPA. We describe a patient with breast malignancy and incidentally detected ALCAPA; primacy was given to treatment of the oncologic condition as a first step. Anesthesia management was focused on maintaining adequate collateral coronary perfusion and avoidance of excessive loading of the left ventricle. This was achieved using a simplified transthoracic echocardiography (TTE) protocol at the time of induction of anesthesia; TTE was also used to reconfirm the absence of disturbances in myocardial function at the end of surgery. We sugggest the routine use of tte in managing perioperative care in low resource settings when the underlying cardiac disease is rare and the evidence base if often insufficient.<\/jats:p>","DOI":"10.4103\/0971-9784.210402","type":"journal-article","created":{"date-parts":[[2017,7,12]],"date-time":"2017-07-12T05:07:37Z","timestamp":1499836057000},"page":"372-375","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["The Utility of Targeted Perioperative Transthoracic Echocardiography in Managing an Adult Patient with Anomalous Origin of the Left Coronary Artery-pulmonary Artery for Noncardiac Surgery"],"prefix":"10.4103","volume":"20","author":[{"given":"Anudeep","family":"Jafra","sequence":"first","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suman","family":"Arora","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aveek","family":"Jayant","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20250920","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1136\/hrt.58.4.378","article-title":"Anomalous left coronary artery from the pulmonary artery: A 15 year sample","volume":"58","author":"Menahem","year":"1987","journal-title":"Br Heart J"},{"key":"R2-20250920","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1111\/j.1460-9592.1996.tb00358.x","article-title":"The Bland-White-Garland syndrome. Clinical picture and anaesthesiological management","volume":"6","author":"Kleinschmidt","year":"1996","journal-title":"Paediatr Anaesth"},{"key":"R4-20250920","doi-asserted-by":"crossref","first-page":"87","DOI":"10.3389\/fpubh.2014.00087","article-title":"Delay in breast cancer: Implications for stage at diagnosis and survival","volume":"2","author":"Caplan","year":"2014","journal-title":"Front Public Health"},{"key":"R5-20250920","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1510\/icvts.2009.209627A","article-title":"Incomplete left ventricular reverse remodeling after revascularization of anomalous left coronary artery from the pulmonary artery","volume":"10","author":"Edwin","year":"2010","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"R6-20250920","doi-asserted-by":"crossref","first-page":"1056.e1","DOI":"10.1016\/j.echo.2011.03.016","article-title":"Echocardiographic marker for Bland-White-Garland syndrome in adult","volume":"24","author":"Selmi","year":"2011","journal-title":"J Am Soc Echocardiogr"},{"key":"R7-20250920","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1053\/j.jvca.2009.01.018","article-title":"Focused cardiovascular ultrasound performed by anesthesiologists in the perioperative period: Feasible and alters patient management","volume":"23","author":"Cowie","year":"2009","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"R8-20250920","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.echo.2014.10.003","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"28","author":"Lang","year":"2015","journal-title":"J Am Soc Echocardiogr"},{"issue":"12 Suppl","key":"R9-20250920","first-page":"S410","article-title":"Adult congenital heart disease: A growing epidemic","volume":"30","author":"\u00c1vila","year":"2014","journal-title":"Can J Cardiol"},{"key":"R10-20250920","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/0002-8703(83)90207-7","article-title":"Anomalous origin of the left coronary artery from the pulmonary artery (Bland-White-Garland syndrome) in adult patients: Long-term follow-up after surgery","volume":"106","author":"Moodie","year":"1983","journal-title":"Am Heart J"},{"issue":"Suppl 3","key":"R11-20250920","doi-asserted-by":"crossref","first-page":"S29","DOI":"10.1016\/j.hlc.2007.05.004","article-title":"Anomalous origin of left coronary artery from the pulmonary artery does the management in the adult differ from that of the infant? Four cases of the Bland-White-Garland syndrome","volume":"16","author":"Karunadasa","year":"2007","journal-title":"Heart Lung Circ"},{"key":"R12-20250920","doi-asserted-by":"crossref","first-page":"2449","DOI":"10.1161\/01.CIR.0000016175.49835.57","article-title":"Coronary anomalies: Incidence, pathophysiology, and clinical relevance","volume":"105","author":"Angelini","year":"2002","journal-title":"Circulation"},{"key":"R14-20250920","doi-asserted-by":"crossref","first-page":"5706","DOI":"10.2174\/1381612820666140204120829","article-title":"Anesthetic cardioprotection in clinical practice from proof-of-concept to clinical applications","volume":"20","author":"Zaugg","year":"2014","journal-title":"Curr Pharm Des"},{"key":"R15-20250920","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1093\/bja\/aeu290","article-title":"Volatile compared with total intravenous anaesthesia in patients undergoing high-risk cardiac surgery: A randomized multicentre study","volume":"113","author":"Landoni","year":"2014","journal-title":"Br J Anaesth"},{"key":"R16-20250920","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1016\/j.ahj.2014.07.009","article-title":"Sevoflurane in acute myocardial infarction: A pilot randomized study","volume":"168","author":"Lavi","year":"2014","journal-title":"Am Heart J"},{"key":"R17-20250920","doi-asserted-by":"crossref","first-page":"e77","DOI":"10.1016\/j.jacc.2014.07.944","article-title":"2014 ACC\/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery","volume":"64","author":"Fleisher","year":"2014","journal-title":"J Am Coll Cardiol"},{"key":"R18-20250920","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1097\/ALN.0000000000000113","article-title":"Myocardial injury after noncardiac surgery: A large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes","volume":"120","author":"Devereaux","year":"2014","journal-title":"Anesthesiology"}],"container-title":["Annals of Cardiac Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/00660469-201720030-00021","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T13:48:02Z","timestamp":1787838482000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00660469-201720030-00021"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,7]]},"references-count":16,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2017]]}},"URL":"https:\/\/doi.org\/10.4103\/0971-9784.210402","relation":{},"ISSN":["0971-9784","0974-5181"],"issn-type":[{"value":"0971-9784","type":"print"},{"value":"0974-5181","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,7]]}}}