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OCT: A Modality for Identifying Stent Failure in Pediatric Patients With Angiographically Silent Coronary Arteries

Ruochen Mao1, James-Yashu Coe2, Kunal Minhas3

  • 1Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.

JACC. Case Reports
|July 28, 2021
PubMed

Insights

A teenager with a rare congenital heart defect, anomalous left coronary artery from the pulmonary artery, experienced cardiac arrest. The patient outgrew a childhood stent, leading to significant narrowing and requiring intervention.

Area of Science:

  • Congenital Cardiovascular Anomalies
  • Interventional Cardiology
  • Pediatric Cardiology

Background:

  • Anomalous left coronary artery from the left pulmonary artery (ALCAPA) is a rare congenital heart defect.
  • Surgical or interventional correction in infancy is standard management.
  • Long-term outcomes and potential need for reintervention are not well-defined.

Observation:

  • A 16-year-old patient with a history of ALCAPA treated with percutaneous coronary intervention (PCI) in infancy presented with ventricular fibrillation arrest.
  • Coronary angiography showed in-stent restenosis.
  • Optical coherence tomography (OCT) revealed significant native left main coronary artery stenosis, indicating the patient had outgrown the implanted stent.

Findings:

  • The patient's ALCAPA, treated in infancy, recurred with significant left main coronary artery stenosis.
  • The existing stent was inadequate due to somatic growth, leading to critical narrowing.
  • Ventricular fibrillation arrest was the presenting emergency complication.

Implications:

  • This case highlights the potential for late complications in patients with ALCAPA treated with PCI.
  • It underscores the importance of long-term surveillance and potential need for repeat interventions in pediatric patients with congenital coronary anomalies.
  • Advanced imaging like OCT is crucial for accurate stenosis assessment and guiding management in complex coronary artery disease.

Keywords:
ACE, angiotensin-converting enzymeALCAPAALCAPA, with anomalous left coronary artery from the left pulmonary arteryCMR, cardiac magnetic resonanceDES, drug-eluting stentECG, electrocardiogramLMCA, left main coronary arteryLV, left ventricularMLA, minimum lumen areaOCTOCT, optical coherence tomographyPCIPCI, percutaneous coronary interventionTTE, transthoracic echocardiographylong-term survivaloutgrown stent

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