Myocardial Infarction and Left Coronary Ostial Stenosis in Infancy Simulating Anomalous Origin of the Left Coronary Artery

Abstract

SUMMARYA case of a 3-month-old male infant with myocardial infarction due to left coronary ostial stenosis is presented.Clinically it was quite similar to anomalous origin of the left coronary artery.Aortogram demonstrated hypoplastic left coronary artery.Postmortem examination revealed quite narrow left coronary ostium and myocardial infarction with aneurysm of the left ventricular apex. AdditionalIndexing Words: Myocardial infarction Coronary ostial stenosis M YOCARDIAL infarction in infancy is rare and may result from one of the several conditions. Aberrant left coronary artery from the pulmonary artery may be the most common cause of myocardial infarction in infancy.1) Recently in Japan acute febrile mucocutaneous lymph node syndrome2),3) is attracted attention as a cause of myocardial infarction in infancy. This report presents an infant who suffered from myocardial infarction due to left coronary ostial stenosis which was clinically similar to anomalous origin of the left coronary artery from the pulmonary artery. CASE REPORTA 10-day-old Japanese male infant was admitted to Nihon University Hospital because of convulsion. He was delivered from a 22-year-old mother at 39 weeks' gestation by Cesarian section because of breech presentation. His birth weight was 2,550Gm. He had been well until 6 days old when he developed convulsion and was admitted to the hospital. Serum calcium level was 7.2mg/100ml, phosphate From the

Congenital atresia of the orifice of the left coronary artery

“…Musiani and his colleagues 20 reviewed 26 cases from the literature and added two more. Other reported cases, 3,4,7,8,13,18,[28][29][30] together with the present case, bring the total published, to the best of our knowledge, to 41 cases. Becker 31 considers that the condition fits into the designation of single coronary artery, and from a functional point of view this is logical.…”

“…A delayed onset of ischaemia in infancy, nonetheless, is not uncommon with congenital atresias. [4][5][6][7][8] It has been suggested that this may be due to aggravation of an impending ischaemia by growth of the infant and increasing physical activity. 9 Ischaemia may even be delayed until late adult life, when atherosclerosis becomes a complicating factor.…”

“…Clinical evidence of myocardial ischaemia, and angiographic findings, may lead to a diagnosis of anomalous origin of a coronary artery from the pulmonary trunk. [5][6][7][8][9] As in our case, the true nature of the abnormality may only become evident at surgery. Although there may be different clinical presentations, there does not appear to be a rigid anatomical distinction between single coronary artery, of the types reviewed and classified by Smith 34 and Allen & Snider, 39 and isolated atresia of the left coronary orifice.…”

Neonatal myocardial infarction and the role of extracorporeal membrane oxygenation

“…It is most often due to abnormal origin of the left coronary artery from the pulmonary artery (ALCAPA), or fibrous stenosis of a coronary ostium or the coronary artery wall 4 5. In a newborn infant without structural heart disease, infarction is probably due to paradoxical systemic embolism of placental or renal vascular thrombi, which cross the patent foramen ovale to the systemic circulation 3 6 7.…”