Percutaneous left main coronary artery stent for acute myocardial ischemia after repaired ALCAPA
Anna Hallbergson1, Jonathan J Rome
1Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine and the University of Pennsylvania, Philadelphia, Pennsylvania; Children's Heart Center, Skane University Hospital, Lund, 221 85, Sweden.
Insights
Coronary artery stent angioplasty in infants is rare but feasible. A 3kg infant with anomalous coronary artery received a stent, showing full recovery and normalized function.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Percutaneous coronary artery stent angioplasty is a rare but potentially life-saving intervention in pediatric patients with coronary artery obstruction.
- The procedure is technically challenging in infants due to their small size and the potential need for future surgical interventions.
Observation:
- A case report details an infant with anomalous left coronary artery from the pulmonary artery who underwent successful surgical reimplantation.
- One month post-surgery, the infant developed acute myocardial ischemia due to near-total left coronary artery occlusion.
- Emergent cardiac catheterization and percutaneous coronary intervention (PCI) were performed.
Findings:
- A 2.5 mm coronary stent was successfully implanted in the left main coronary artery, rapidly reestablishing coronary blood flow.
- The patient, weighing 3 kg and under 6 weeks of age, represents the smallest and youngest patient reported to undergo coronary stent angioplasty.
- Left ventricular systolic function recovered within 4 weeks, and angiography at 3 months showed complete normalization of the coronary artery system.
Implications:
- This case demonstrates the feasibility of coronary stenting in infants as a temporizing measure for hemodynamic instability caused by coronary artery stenosis.
- The procedure can lead to significant recovery of cardiac function and normalization of coronary anatomy in select pediatric cases.
- Long-term follow-up showed sustained normal left ventricular systolic function and overall clinical well-being from a cardiac perspective.
Abstract:
Percutaneous coronary artery stent angioplasty is rare in the pediatric population but can be a life-saving by rapidly reestablishing flow to an obstructed coronary artery. It is a technically challenging and high-risk procedure in infants and further limited by the need for future surgical intervention. We report of an infant with anomalous left coronary artery from the pulmonary artery who underwent acutely successful surgical reimplantation of the left coronary artery onto the ascending aorta. One month later, she developed acute myocardial ischemia and emergent catheterization diagnosed near-total occlusion of the left coronary artery. We implanted a 2.5 mm coronary stent in the left main coronary artery with reestablishment of flow. The patient's left ventricular systolic function recovered within 4 weeks and repeat angiography 3 months later showed complete normalization of the entire left coronary artery system. The patient weighed 3 kg and was < 6 weeks of age at the time of stent implantation which to our knowledge is the smallest and youngest reported patient to undergo coronary stent angioplasty. This case supports the feasibility of this procedure in infants as a temporizing solution to hemodynamic instability from myocardial ischemia due to coronary artery stenosis. The left ventricular systolic function remained normal at 7 months after stent placement and the patient was clinically well from a cardiac perspective.
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