Anomalous left coronary artery from pulmonary artery Case series and brief review英文文献资料.docVIP

Open Journal of Pediatrics, 2012, 2, 77-81 OJPed /10.4236/ojped.2012.21013 Published Online March 2012 (http://www.SciRP.org/journal/ojped/) Anomalous left coronary artery from pulmonary artery: Case series and brief review Muhammad Dilawar , Zaheer Ahmad 1* 2 1 2 Hamad Medical Corporation, Doha, Qatar Southampton University Hospital, Southampton, UK dilawarmd@, drzaheer@ Email: * Received 8 August 2011; revised 10 October 2011; accepted 30 November 2011 ABSTRACT anomaly causes coronary blood steal to pulmonary artery leading to myocardial ischemia and if left untreated can lead to dilated cardiomyopathy and death. The mortality of untreated ALCAPA has been estimated to be more than 90% during first year of life [2]. However, patients can survive past infancy and even into adulthood without being symptomatic until later in life. In teenagers and adults, ALCAPA may be an important cause of malignant ventricular arrhythmias and sudden cardiac arrest [3]. Classically, ALCAPA patients present at 2 - 6 weeks of age with history of irritability and inconsolable crying during feeding and with symptoms/signs of heart failure i.e. tachypnea, tachycardia, sweating, poor weight gain, cool extremities, weak pulses, hepatomegaly, crepita- tions and cardiomegaly with plethoric lung fields. Elec- trocardiogram reveals deep Q waves and ST-T wave changes in infero-lateral leads and echocardiogram shows poor left ventricular function with possible septal-wall motion abnormalities, mitral valve regurgitation and col- laterals flowing in to ALCAPA which ultimately drains in to pulmonary artery. In rare instances, the clinical picture may be atypical and ECG or echocardiogram may not be classical for the diagnosis of ALCAPA. In such atypical cases, cardiac catheterization or computer- ized axial tomographic scan (CT scan)/magnetic reso- nance angiograp