Affiliation:
1. Adult Cardiology Department, King Fahad Medical City , Dabab street, Sulaimaniya, PO Box 221124, Riyadh 11311 , Saudi Arabia
Abstract
Abstract
Background
Anomalous origin of the coronary artery from the pulmonary artery (ALCAPA) is a rare congenital disease. Surgical re-implantation of the left main coronary artery (LMCA) to the aorta is a definitive treatment with a good prognosis.
Case summary
A 9-year-old boy was admitted with a complaint of exertional chest pain and dyspnoea. At 13 months of age, he was diagnosed to have ALCAPA as a workup of severe left ventricular systolic dysfunction and underwent coronary re-implantation of ALCAPA. Coronary angiogram displayed the high takeoff of re-implanted LMCA with significant ostial stenosis, and echocardiogram showed significant supravalvular pulmonary stenosis (SVPS) with a peak gradient of 74 mmHg. After a multidisciplinary team discussion, he underwent percutaneous coronary intervention with stenting to ostial LMCA. On follow-up, he was asymptomatic and a cardiac computed tomography scan showed a patent stent in LMCA with an under-expanded area in the mid-segment. The proximal part of the LMCA stent was located very close to the stenotic segment of the main pulmonary artery making it a high risk for balloon angioplasty. The surgical intervention of SVPS is delayed to allow the somatic growth of the patient.
Discussion
Percutaneous coronary intervention in re-implanted LMCA is a feasible option. If stenosis of re-implanted LMCA is accompanied by SVPS, the latter can be best treated surgically and staged to decrease the operative risk. Our case also demonstrates the importance of long-term follow-up of post-operative complications of patients with ALCAPA.
Publisher
Oxford University Press (OUP)
Subject
Cardiology and Cardiovascular Medicine
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