Case Report: Neonatal Complex Congenital Heart Disease With Anomalous Origin of the Left Coronary Artery From the Right Pulmonary Artery: Analysis of Missed Diagnosis and Improvement Procedures

Abstract

The anomalous origin of the left coronary artery from the right pulmonary artery is a rare type of congenital disease. It is even rarer when combined with complex congenital heart diseases requiring surgical intervention in the neonatal period. Because it has no clinical manifestations in the neonatal period, it is easier to miss diagnosis when combined with complex congenital heart disease. To avoid a missed diagnosis of anomalous origin of the left coronary artery from the right pulmonary artery, preoperative echocardiography should routinely explore the orifice of the coronary artery. However, the preoperative examination can lead to missed diagnosis due to the influence of the examiner's experience, equipment, and other factors. After thoracotomy, exploring the orifice position of the left and right coronary arteries can avoid a missed diagnosis of the abnormal origin of coronary arteries. An exploration of the coronary artery is mainly recommended for children with complex congenital heart disease in the neonatal period and children with congenital heart disease combined with unexplained cardiac insufficiency and abnormal mitral valve development.

Aberrant left coronary artery from the pulmonary artery with patent ductus arteriosus - A case report and review of the literature

“…The clinical presentation following PDA closure is dramatic in all cases. Most develop immediate hemodynamic shock or ventricular arrhythmia (13,(17)(18)(19), and some develop CHF with severely decreased LV function (10)(11)14). The diagnosis of ALCAPA following PDA repair might be delayed, especially in cases with a non-catastrophic presentation.…”

Aberrant left coronary artery from the pulmonary artery with patent ductus arteriosus - a case report and review of the literature

“…The clinical presentation following PDA closure is dramatic in all cases. Most develop immediate hemodynamic shock or ventricular arrhythmia [12,14,18,19], and some develop CHF with severely decreased LV function 15). The diagnosis of ALCAPA following PDA repair might be delayed, especially in cases with a non-catastrophic presentation.…”

“…Both of these cases are from the 80s; surgical and anesthesia techniques and expertise have evolved since. The third case of mortality described an infant with severe comorbidity, a hypoplastic aortic arch, who was diagnosed in the operating room following weaning off bypass; he also didn't survive the surgery [19].…”