Déjà Vu: Recurrent Sudden Cardiac Arrests in a Child With an Anomalous Left Coronary Artery

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease
• Cardiac Electrophysiology

Background:

• Anomalous aortic origin of a coronary artery (AAOCA) from the opposite sinus of Valsalva is a rare congenital heart defect.
• It can lead to myocardial ischemia and sudden cardiac arrest, particularly during exertion.
• Incidence in infants under 10 years old is exceptionally low.

Observation:

• A 7-week-old infant presented with a brief resolved unexplained event.
• The infant was diagnosed with left AAOCA and underwent surgical unroofing.
• At 8 years of age, the patient experienced recurrent syncope.

Findings:

• Stress echocardiography revealed myocardial ischemia in the infant during both the initial event and the later syncope episode.
• This suggests persistent or recurrent ischemia despite surgical intervention.
• Recurrent syncope in childhood can be a sign of significant underlying cardiac pathology.

Implications:

• This case underscores the importance of considering AAOCA in infants presenting with unexplained events, even if rare.
• It highlights the potential for recurrent ischemia and syncope in children with AAOCA, necessitating long-term monitoring.
• Early and accurate diagnosis through imaging and stress testing is crucial for managing this condition and preventing adverse outcomes.