Intramural Left Coronary Artery in Truncus Arteriosus

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease
• Cardiac Surgery

Background:

• Truncus arteriosus (common arterial trunk) is a complex congenital heart defect.
• Intramural coronary arteries, where the artery courses within the heart wall, are a rare anomaly.
• This association poses unique surgical challenges and risks.

Observation:

• A neonate with truncus arteriosus developed a low cardiac output state and cardiac arrest post-repair.
• Echocardiography and angiography revealed left coronary artery occlusion.
• The patient required extracorporeal membrane oxygenation and emergency reexploration.

Findings:

• Surgical findings included a "slit-like" orifice and an intramural left coronary artery.
• Successful "unroofing" of the intramural segment restored coronary blood flow.
• The neonate experienced a full recovery after the intervention.

Implications:

• Preoperative detailed assessment of proximal coronary anatomy is crucial in truncus arteriosus cases.
• Missed intramural coronary artery segments can lead to severe perioperative complications.
• Early identification and management of this anomaly can prevent significant morbidity and mortality.