Left Main Stem Coronary Artery Stenting in a 3-Month-Old Child After Anomalous Left Coronary Artery from Pulmonary Artery Repair

Excerpt

Coronary artery anomalies are found in approximately 1% of the general population. These vary in severity, with major anomalies (anomalous origin of the left and/or right coronary arteries with a course between the aorta and pulmonary artery, and left coronary artery from the pulmonary artery) thought to account for many cases of sudden cardiac death in young, active individuals [1]. Abnormal origin of the left coronary artery from the pulmonary artery (ALCAPA) accounts for approximately 0.5% of congenital heart defects and usually presents in early infancy (3–6 months of age) [3]. In a series of 15 patients with ALCAPA, most symptoms consisted of difficulty breathing and/or feeding [3]. Angiography was performed in virtually all of the patients to define the anatomy. The findings on echocardiography usually consist of left ventricular dysfunction, mitral valve insufficiency with increased echodensity of the papillary muscles, and a dilated right coronary artery [4].The treatment of choice in patients with ALCAPA is the establishment of a dual coronary artery system with either surgical reimplantation of the left coronary artery in the left coronary sinus or an intrapulmonary artery baffle (Takeuchi procedure) [6, 10]. This surgery should be done urgently due to the chance of sudden death in both asymptomatic and symptomatic patients [11]. Antegrade flow in a two-vessel coronary system is thus reestablished. Ligation of the origin of the left coronary artery as a strategy is now uncommon [2]. …