Diagnosing Left Coronary Ostial Atresia: Sometimes the Old Ways Are Best
Steven Karayiannis1, Brian Anthony McCrossan1, Andrew Sands1
1Department of Paediatric Cardiology, Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland.
Insights
A 12-year-old boy experienced exercise-induced syncope due to left coronary artery ostial atresia. Despite advanced imaging, diagnosis was confirmed by cardiac catheterization, leading to successful bypass surgery.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Coronary Artery Anomalies
Background:
- Intermittent syncope in children can indicate underlying cardiac conditions.
- Exercise-induced symptoms may suggest myocardial ischemia.
- Left main coronary artery anomalies are rare but critical congenital defects.
Abstract:
A 12-year-old boy with intermittent syncope associated with exercise. Exercise stress testing suggested myocardial ischemia and 2D echocardiography failed to confirm antegrade flow in the left main stem. Advanced imaging techniques including cardiac-gated computed tomography angiography and stress cardiac magnetic resonance imaging were falsely reassuring. Cardiac catheterization demonstrated left coronary artery ostial atresia with a good caliber left coronary system supplied by generous collaterals from the right coronary artery. The patient underwent successful coronary artery bypass grafting.
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