Respiratory Syncytial Viral Infection in an Infant with Unrepaired Anomalous Left Coronary Artery from the Pulmonary Artery

Abstract

Abnormal origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare coronary anomaly in children that requires necessary and urgent repair. We report a child who was hospitalized with respiratory failure due respiratory syncytial viral (RSV) infection and was subsequently diagnosed with ALCAPA. Aggressive treatment for RSV included synagis and nebulized ribavirin prior to surgical repair. After waiting 4 weeks for the RSV infection to resolve, she underwent successful left coronary artery reimplantation on hospital day 27 and has regained normal left ventricular size and function.

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

“…The only similar case reported in the literature, a 4-month-old female who had respiratory failure after RSV infection with unrepaired ALCAPA, was surgically treated on the 27 th hospital day. In that case, the troponin I and CK-MB levels and electrocardiograms were evaluated daily to assess for ongoing myocardial ischemia (8). We planned the surgery on 14 th day after admission, and no postoperative complication related to the recent RSV infection was observed.…”

Repair of Anomalous Left Coronary Artery From Pulmonary Artery in an Infant With Respiratory Syncytial Virus Bronchiolitis

“…6 For some, when faced with active RSV infection, treatment with bronchodilators and palivizumab with delayed surgical intervention until the RSV antigen test and viral culture are negative has been advocated. 3 Without clear data on the impact of active RSV on recovery from cardiac surgery, the decision to operate requires a team-based approach with a careful assessment of risk versus benefit in each case. In our patient, all RSV symptoms were mild prior to surgical intervention.…”

“…Anomalous left coronary artery from the pulmonary artery (ALCAPA) occurs in approximately one in every 300,000 children and the untreated mortality exceeds 90% within the first year of life. 1,2 Although there are reports of successful reimplantation of the anomalous coronary artery in patients following a delay in surgical correction to allow for aggressive treatment of respiratory syncytial virus (RSV) infection, 3 immediate revascularization in the presence of active RSV bronchiolitis has never been reported.…”