Anomalous Origin of Left Coronary Artery from Pulmonary Artery (ALCAPA) in an Infant with Bronchiolitis and Dilated Cardiomyopathy

Abstract

The most common cause of dilated cardiomyopathy (CMP) is viral myocarditis. However, anomalous origin of the left coronary artery is a rare condition that should be evaluated with high suspicion in the differential diagnosis of an infant with dilated CMP. With early surgical correction, an anomalous coronary artery origin has a good prognosis. Awareness of this condition is essential for prompt diagnosis. This article reports a 5 months-old infant with dilated cardiomyopathy in the setting of RSV bronchiolitis. Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) was the final diagnosis in the infant, who presented as viral myocarditis with RSV infection. She was operated successfully with the direct reimplantation of the coronary artery to the aorta. (Jo ur nal of Cur rent Pe di at rics 2013; 11: 142-5) Dilate kardiyomyopatinin en yaygın nedeni viral myokardittir. Bununla birlikte sol koroner arterin pulmoner arterden çıkış anomalisi nadir bir durum olup dilate kardiyomyopatinin etiyolojisinde yüksek şüphe ile irdelenmelidir. Erken cerrahi düzeltme ile koroner arter çıkış anomalisinin prognozu iyidir. Bu bozukluğun farkındalığında olmak hızlı teşhis için önemlidir. Makalede 5 aylık bir süt çocuğunda RSV bronşioliti zemininde gelişen dilate kardiyomopati olgusu bildirilmektedir. RSV infeksiyonu ile viral myokardit geliştiği düşünülen bebekte kesin tanı sol koroner arterin pulmoner arterden çıkış anomalisi (ALCAPA) idi. Sol koroner arterin aortaya doğrudan reimplantasyon ameliyatı başarı ile sağlandı. (Gün cel Pe di at ri 2013; 11: 142-5) Anah tar ke li me ler: ALCAPA, kardiyomyopati, infant, myokardit, RSV bronşioliti Ad dress for Cor res pon den ce/Ya z›fl ma Ad re si:

Correctable Cause of Dilated Cardiomyopathy in an Infant with Heart Failure: ALCAPA Syndrome

“…ALCAPA syndrome generally occurs as an isolated cardiac anomaly but can also be concomitant with congenital heart defects such as patent ductus arteriosus, ventricular septal defect, pulmonary stenosis, Tetralogy of Fallot and aortic coarctation (5,(8)(9)(10).…”

“…As a compensatory mechanism, RCA dilates and collateral vessels are formed between RCA and ALCA. Symptoms manifest themselves in the 2 nd -3 rd month of life in 80-90% of cases (3,8). Clinical signs include angina-related pain in the form of acute distress, feeding problems, weight loss, tachycardia, tachypnea and sudden death.…”

“…Eventually, cardiomegaly and congestive heart failure develop. LV performance and onset of symptoms depend on PA pressure and collaterals (5,(8)(9)(10)(11). Our patient was asymptomatic at birth and was referred to us at 2.5 months of age with heart failure findings.…”

“…Previous studies have found that ALCAPA patients do not receive a correct diagnosis after the first In order to diagnose ALCAPA, one must look for indirect findings (14,15). If a neonate presents with bronchiolitis and heart failure, displays cardiomegaly on telecardiogram and pathologies on ECG, then DCM and ALCAPA must be considered in terms of differential diagnosis (2,5,(8)(9)(10)13).…”