Late intervention in an asymptomatic pediatric patient with anomalous left coronary artery

Abstract

Anomalous left coronary artery from the pulmonary artery (ALCAPA) is most commonly diagnosed within the first year of life with congestive heart failure symptomatology reflecting left ventricle (LV) dysfunction. The late diagnosis of ALCAPA is presented in a 5-year-old without significant LV dysfunction, mild LV dilatation and only mild mitral regurgitation that did not change significantly after surgery. The timing of surgical intervention in the late diagnosis of ALCAPA remains unclear despite risks of significant ongoing myocardial injury secondary to coronary artery hypoperfusion and progressive mitral valve dysfunction. Intervention in this case allows for revascularization which may reverse ventricular and valvular dysfunction.

Keywords: Congenital heart disease; Congenital heart surgery; Coronary artery imaging; Coronary artery surgery; Reperfusion

Core tip: This case report presents the rare case of a late diagnosis of anomalous left coronary artery from the pulmonary artery and the associated challenge with determining the need for surgical revascularization in the absence of symptomatology and definitive literature. Late surgical intervention undertaken in this patient may reverse ongoing myocardial dysfunction and prevent permanent left ventricular damage.