An 8-month-old girl with an anomalous left coronary artery from the pulmonary artery complicated by myocardial ischemia after surgical reimplantation (original) (raw)
2006, Journal of Nuclear Cardiology
Case report. An 8-month-old girl presented with poor ventricular function and mitral insufficiency after reimplantation of an anomalous left coronary artery at another institution. After her mother had a full-term uncomplicated pregnancy, at age 3 months, the patient had been evaluated for shortness of breath with feeding. She was found to have congestive heart failure and a cardiac murmur. Left heart catheterization and coronary angiography revealed an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). The patient underwent open-heart surgery with surgical reimplantation of the left coronary artery to the anterior aspect of the ascending aorta on Nov 30, 2004, at another institution. She had a slow postoperative recovery, requiring mechanical ventilation for 1 week after surgery. Upon discharge, she showed clinical improvement and did well for some time. At age 7 months, the patient was not gaining weight appropriately and was reevaluated for coronary ischemia. Left heart catheterization on March 14, 2005, revealed an enlarged left atrium and left ventricle, as well as a reduced left ventricular (LV) ejection fraction (EF) of 18%. Right heart catheterization was normal. Coronary angiography revealed significant narrowing and near occlusion of the left main coronary artery. The right coronary artery was observed to be enlarged and provided collateral flow to the left coronary system. At that point, the patient came to the Cleveland Clinic (Cleveland, Ohio) for a second opinion. Echocardiography at our institution revealed moderate LV dilatation (2.8 cm in diastole) and mild LV systolic dysfunction (EF, 50%). Given the uncertainty about the significance of the lesion in the left main coronary artery and the discrepancy in LV function, an alternative functional test was considered. The patient proceeded to cardiac positron emission
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