2018 Volume 82 Issue 10 Pages 2680-2681
An 11-year-old boy with no previous history was transported to the emergency room after an aborted cardiac arrest during soccer training. Bystander cardiopulmonary resuscitation and automatic external defibrillation (AED) restored spontaneous circulation. Ventricular fibrillation was recorded on AED, and electrocardiogram showed ST-segment depression in the anterolateral leads. Echocardiography indicated a dilated left ventricle with mitral valve regurgitation. Both right and left coronary arteries (RCA and LCA) were significantly dilated (Figure A,B; arrows). The LCA was expected to originate from the left aortic sinus but the flow direction was inverted on color Doppler imaging (Figure C; arrow, retrograde flow of LCA). Furthermore, abundant vascular networks crossing the interventricular septum and anterior surface of the ventricular wall, from right to left, were seen (Figure D; Movie S1). Cardiac computed tomography showed the LCA originating from the pulmonary artery (Figure E). The origin of the LCA was not directly visualized on aortography. RCA angiography showed a dilated RCA that provided retrograde collateral flow to the LCA and perfused the main pulmonary artery (Figure F; Movie S2). After intensive care, surgical translocation, and reimplantation of the LCA, the patient was discharged after 7 uneventful, postoperative days.
(A,B) Transthoracic echocardiography, right and left coronary arteries (RCA and LCA) were significantly dilated (arrows); (C) Color Doppler image, retrograde flow of LCA (arrow); (D) Color Doppler image, abundant vascular networks inside the heart; (E) Contrast computed tomography, LCA originating form the pulmonary artery (arrow); (F) RCA angiography, retrograde collateral flow to the LCA and perfused the main pulmonary artery (arrows).
Anomalous left coronary artery from the pulmonary artery is a rare disease with a high mortality when it remains uncorrected during infancy. Most patients present with symptoms before 6 months old, but some few survive asymptomatically to an older age. Well-developed intercoronary collateral vessels are associated with improved clinical course and prognosis.1 Exercise therefore has the potential to bring such rare cardiac disorders to the physician’s attention.
The authors would like to thank Mr. Bryan J. Mathis for native-speaker revision.
The authors declare no conflicts of interest.
None.
Supplementary File 1
Movie S1. Abundant vascular networks crossing the interventricular septum and anterior surface of the ventricular wall, from right to left, were visualized.
Supplementary File 2
Movie S2. RCA angiography demonstrated a dilated RCA which provided retrograde collateral flow to the LCA and perfused the main pulmonary artery.
Please find supplementary file(s);
http://dx.doi.org/10.1253/circj.CJ-18-0075
