Case Report: Neonatal Complex Congenital Heart Disease With Anomalous Origin of the Left Coronary Artery From the Right Pulmonary Artery: Analysis of Missed Diagnosis and Improvement Procedures.

Zhen Bing,Qian Cao,Wen Ge,Rui Chen,Leilei Liu

doi:10.3389/fped.2021.805632

Abstract

The anomalous origin of the left coronary artery from the right pulmonary artery is a rare type of congenital disease. It is even rarer when combined with complex congenital heart diseases requiring surgical intervention in the neonatal period. Because it has no clinical manifestations in the neonatal period, it is easier to miss diagnosis when combined with complex congenital heart disease. To avoid a missed diagnosis of anomalous origin of the left coronary artery from the right pulmonary artery, preoperative echocardiography should routinely explore the orifice of the coronary artery. However, the preoperative examination can lead to missed diagnosis due to the influence of the examiner's experience, equipment, and other factors. After thoracotomy, exploring the orifice position of the left and right coronary arteries can avoid a missed diagnosis of the abnormal origin of coronary arteries. An exploration of the coronary artery is mainly recommended for children with complex congenital heart disease in the neonatal period and children with congenital heart disease combined with unexplained cardiac insufficiency and abnormal mitral valve development.

Highlights

The anomalous origin of the left coronary artery from the right pulmonary artery (ALCAPA) is a rare type of congenital disease
In the neonatal period of complex congenital heart diseases (CHDs), if the diagnosis of ALCAPA is missing, the myocardium in the blood supply area of the left coronary artery cannot be protected after a cardioplegia solution is perfused at the root of the aorta
The direct signs include that the left coronary artery is not connected with the left coronary sinus of the aorta, but with the pulmonary artery, and the blood flow of the left coronary artery retrogradely enters the pulmonary artery in diastole

Summary

INTRODUCTION

The anomalous origin of the left coronary artery from the right pulmonary artery (ALCAPA) is a rare type of congenital disease. We report a neonate with complex CHD It was diagnosed as coarctation of the aorta with arch hypoplasia, ventricular septal defect (VSD), atrial septal defect (ASD), and patent ductus arteriosus (PDA). Anomalous Origin of Coronary Artery impossible to get out of cardiopulmonary bypass due to severe left cardiac insufficiency, which eventually led to death. On the 13th day after birth, under general anesthesia and hypothermic cardiopulmonary bypass, the children underwent a correction of the coarctation of the aorta with severe tubular arch hypoplasia, a repair of the VSD, a repair of the ASD, and a closure of the PDA. After prolonged cardiopulmonary bypass time, the left ventricular function did not improve, and the heart rate and blood pressure decreased. Vasoactive drugs could not be maintained, and the patient eventually died

DISCUSSION

ETHICS STATEMENT