[Cardiac arrest in a five month old boy with ALCAPA]

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease
• Neonatal Pathology

Background:

• Anomalous origin of the coronary artery from the pulmonary artery (ALCAPA) is a rare but critical congenital heart defect.
• It typically presents in infancy with symptoms mimicking respiratory illness, often delaying diagnosis.

Observation:

• A five-month-old male infant presented with asthmatic bronchitis symptoms, failure to thrive, persistent cough, and episodes of severe crying.
• Clinical examination revealed cardiomegaly, and electrocardiogram (ECG) showed ischemic changes (Q waves, ST segment elevation).

Findings:

• The infant experienced sudden deterioration and died of cardiac arrest.
• Autopsy confirmed myocardial infarction and fibrosis, revealing the underlying cause: anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA).

Implications:

• This case highlights the importance of considering cardiac pathology in infants presenting with seemingly respiratory symptoms.
• Subtle clinical signs and ECG findings can be critical indicators of ALCAPA, necessitating prompt diagnostic evaluation.
• Timely diagnosis and surgical intervention are vital for improving outcomes in infants with ALCAPA.