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Fatal coronary artery anomaly presenting as bronchiolitis
Marco Piastra1, Giancarlo Polidori, Maria Pia De Carolis
1Paediatric Intensive Care Unit, Policlinico A. Gemelli, L.go A. Gemelli 8, 00168 Rome, Italy. xoct01@yahoo.it
European Journal of Pediatrics
|May 13, 2005
Summary
Respiratory syncytial virus bronchiolitis can mask a rare congenital heart defect: anomalous origin of the left coronary artery from the pulmonary trunk. This condition can lead to severe cardiogenic shock in infants.
Area of Science:
- Pediatric Cardiology
- Neonatal Respiratory Illness
- Congenital Heart Defects
Background:
- Respiratory syncytial virus (RSV) bronchiolitis is a common cause of infant hospitalization.
- Congenital heart defects can present with non-specific symptoms in infancy.
Observation:
- Three infants with severe RSV bronchiolitis presented with wheezing and respiratory distress.
- Two infants rapidly deteriorated into intractable shock, indicating a cardiac origin.
- One infant had a subacute presentation allowing for timely cardiological assessment.
Findings:
- All three infants were diagnosed with anomalous origin of the left coronary artery from the pulmonary trunk.
- Concurrent viral infection exacerbated the underlying cardiac anomaly, leading to refractory cardiogenic shock and death in two cases.
Implications:
- Severe wheezing in infants may warrant consideration of underlying cardiac pathology.
- Early pediatric cardiology evaluation, including echocardiography, is crucial for diagnosing rare coronary artery anomalies.
- Prompt diagnosis and management of anomalous left coronary artery from the pulmonary trunk can improve infant outcomes.