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Beta-Blockade in Intraseptal Anomalous Coronary Artery With Reversible Myocardial Ischemia
Tam T Doan1, Athar M Qureshi1, Shagun Sachdeva1
1Coronary Artery Anomalies Program (CAAP), The Lillie & Frank Abercrombie Section of Cardiology, 3984Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
Insights
An anomalous origin of the left coronary artery (L-AAOCA) can cause heart problems. In a rare case, β-blockade therapy successfully resolved symptoms and ischemia in a child with L-AAOCA.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Anomalous aortic origin of a left coronary artery (L-AAOCA) is a rare congenital heart defect.
- Intraseptal L-AAOCA can lead to myocardial ischemia and sudden cardiac death.
- Current management strategies for L-AAOCA lack proven efficacy in improving outcomes.
Observation:
- A 7-year-old boy presented with nonexertional chest pain and syncope.
- Provocative testing revealed reversible myocardial ischemia.
- The patient was diagnosed with intraseptal L-AAOCA.
Findings:
- The patient was treated with β-blockade therapy.
- Symptoms of chest pain and syncope resolved over six years.
- Follow-up imaging (dobutamine stress MRI) and cardiac catheterization showed no evidence of ischemia or coronary flow compromise.
Implications:
- β-blockade may be a viable medical management option for symptomatic intraseptal L-AAOCA in children.
- This case suggests a potential non-surgical approach to managing L-AAOCA.
- Further research is warranted to evaluate the long-term efficacy and safety of β-blockade for L-AAOCA.
Abstract:
Anomalous aortic origin of a left coronary artery (L-AAOCA) with an intraseptal course is a rare anomaly and can be associated with myocardial ischemia and sudden cardiac death. No surgical or medical intervention is known to improve patient outcomes. A 7-year-old boy with intraseptal L-AAOCA presented with nonexertional chest pain, syncope, and had reversible myocardial ischemia on provocative testing. The patient was started on β-blockade, following which his symptoms improved and resolved over a period of six years. A follow-up dobutamine stress magnetic resonance imaging no longer showed reversible ischemia, and cardiac catheterization with fractional flow reserve did not show coronary flow compromise.
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