Budi Rahmat, Radityo Prakoso, Rafles Ph Simbolon, Albert T. Lopolisa, Muhammad Rayhan, Eva M. Marwali
National Cardiovascular Center Harapan Kita and Universitas Indonesia.
Indonesia
Asian Cardiovascular Thoracic Annals
Asian Cardiovasc Thorac Ann 2024;
DOI: 10.1177/02184923241295550
Abstract
Case report: A six-year-old child who had undergone cardiac surgery five years ago presented to us with severe mitral valve regurgitation. During her current surgery, the coronary artery was injured during the attempt to release extensive epicardial adhesion, resulting in very poor contractility that prompted a delay in the intended valve repair. The injured coronary vessels were successfully repaired, yet low cardiac output syndrome persisted during perioperative care, necessitating further investigation of the coronary problem. It was later discovered that the patient had anomalous left coronary artery from pulmonary artery (ALCAPA) syndrome.
Discussion: The presence of severe mitral regurgitation, pulmonary hypertension, and anatomical factors may have contributed to the delayed presentation and diagnosis in this case. The severity of mitral regurgitation and the most likely underlying mechanism indicates a low possibility of recovery following coronary repair alone, warranting the need for concomitant mitral surgery. Coronary and mitral repair were performed in this patient, resulting in a favorable outcome.
Conclusions: The management of ALCAPA presents unique challenges, especially in cases with delayed diagnosis. Proper diagnosis and tailored surgical approaches are crucial for achieving favorable outcomes in patients with ALCAPA.
Category
Class II. Pulmonary Hypertension Associated with Valvular Disease of the Left Side of the Heart
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
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