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A toddler experienced acute coronary ischemia during a routine procedure, a rare pediatric condition. This case highlights the need for further research into pediatric coronary artery disease and its management.

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Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Research
  • Rare Pediatric Diseases

Background:

  • Coronary artery disease and acute coronary ischemia are exceptionally rare in the pediatric population.
  • Children typically do not present with cardiac ischemia, making such cases highly unusual and challenging to diagnose.

Purpose of the Study:

  • To report an extremely rare case of acute diffuse coronary ischemia in a toddler.
  • To investigate the potential underlying causes and diagnostic findings in a pediatric patient with acute coronary ischemia.

Main Methods:

  • Case report of a 22-month-old male with developmental delay and chromosome 1q21.1 microduplication.
  • Utilized multimodal diagnostics including electrocardiogram, cardiac troponin levels, echocardiogram, computed tomography, and cardiac catheterization.
  • Conducted an extensive workup to rule out infectious, rheumatologic, genetic, and thromboembolic etiologies.

Main Results:

  • The toddler presented with refractory hypotension during a urologic procedure under general anesthesia, indicative of acute diffuse coronary ischemia.
  • Diagnostic findings revealed electrocardiogram changes, elevated cardiac troponin, impaired cardiac function, and diffuse coronary vasculopathy.
  • No definitive infectious, rheumatologic, genetic, or thromboembolic cause was identified for the coronary ischemia or chronic cardiac dysfunction.

Conclusions:

  • This case represents an exceptionally rare presentation of acute coronary ischemia in a young child.
  • The etiology of the coronary vasculopathy remains unclear, necessitating further investigation into similar pediatric cases.
  • Management involved mechanical ventilation, vasoactive support, and eventual transition to oral heart failure medication.