Percutaneous coronary intervention in four month old infant for acute myocardial ischemia after repaired ALCAPA

Mirsad Kacila,Merjema Karavdic,Sasa Lukic,Mirza Halimic,Sanko Pandur,Almira Kadic,Nusreta Hadzimuratovic

doi:10.17532/jhsci.2019.871

Abstract

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is rare, but life-threatening condition. The treatment of choice in patients with ALCAPA is the establishment of a dual coronary artery system with surgical reimplantation of the left coronary artery in the left coronary sinus. Percutaneous coronary intervention is infrequent in the pediatric population but can be a life-saving by promptly restoring flow to an obstructed coronary artery. It is a highly demanding and high-risk procedure in infants due to the technical difficulties and the small coronary artery diameter in infants.

Highlights

Anomalies of the coronary arteries can be found in about 1% of the general population
Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), known as Bland-WhiteGarland syndrome, is rare, but life-threatening condition accounts for approximately 0.5% of congenital heart defects and usually gives symptoms early (3-6 months of age)
The small coronary artery diameter in infants contributes to the complexity of percutaneous coronary intervention (PCI) procedures performed in this age group and present a host of periprocedural complications associated with catheter and stent to patient size mismatch: Occlusion ischemia, vessel dissection or rupture, and intimal flaps which can result in myocardial ischemia and infarction [1,2,3]

Summary

INTRODUCTION

Anomalies of the coronary arteries can be found in about 1% of the general population. Percutaneous coronary artery stent angioplasty is infrequent in the pediatric population but can be a life-saving by promptly restoring flow to an obstructed coronary artery In technical sense, it is a highly demanding and high-risk procedure in infants and limited by the need for eventual surgical intervention. At the age of 4 months, the patient was diagnosed with ALCAPA when surgical correction followed by stent placement in LMCA was performed. Twenty-eight months after surgical correction and stent placement, heart catheterization was performed and coronary artery angiogram showed normalization of the left coronary vasculature and no signs of in-stent stenosis (Figure 1). On the 13th post-operative day, catheterization was performed where coronary angiogram showed no antegrade flow in LMCA – aortic anastomosis with LMCA and the tube graft was obstructed.

Findings

DISCUSSION

CONCLUSION