Background Only a few cases have been reported about clinical value of percutaneous coronary intervention and intravascular ultrasound (IVUS) in patients with stenosis of a re-implanted left main coronary artery (LMCA). Case summary We herein report a rare case of restenosis after direct reimplantation of an anomalous origin of the left coronary artery from the pulmonary artery in a 15-year-old girl. At the first evaluation, she had mildly reduced systolic dysfunction with left ventricular ejection fraction (EF) of 47%. Three months after surgical repair, the patient developed recurrent precordial pain. Consequent imaging tests and IVUS revealed a restenosis of the LMCA characterized as an attenuated plaque with a large plaque burden. A drug-eluting stent was implanted with IVUS guidance. Follow-up revealed a patent LMCA and preserved systolic function. Discussion The current case demonstrated that IVUS-guided percutaneous coronary intervention can be feasible in the treatment of coronary artery stenosis after repair of an anomalous origin of the left coronary artery from the pulmonary artery. Further study is needed to explore the pathophysiological mechanism of this condition and the clinical value of percutaneous coronary intervention and IVUS in patients with stenosis of the LMCA.
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