日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

A 12-month-old boy who was diagnosed with a large patent ductus arteriosus (PDA) and pulmonary hypertension (PH) in another hospital was admitted to Chukyo Children Heart Center for catheter intervention. After transcatheter PDA closure, he developed myocardial dysfunction accompanied by elevated cardiac enzyme levels and an abnormal Q-wave on electrocardiography. Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) was detected on follow-up transthoracic echocardiography, and open chest surgery was performed. ALCAPA typically manifests in infancy with signs and symptoms of heart failure that are secondary to ischemic cardiomyopathy. However, it is very difficult to diagnose when additional congenital heart disease, for example, PDA, is present, because left coronary perfusion is maintained by PH. If PDA is treated without the diagnosis of ALCAPA, sudden deterioration may occur. We concluded that we should confirm the origin of the coronary artery using left ventriculography or aortography before transcatheter PDA closure if we cannot rule out the possibility of coronary artery anomalies by careful transthoracic echocardiography.