Accidental finding of ALCAPA in a child with severe mitral regurgitation: A case study

• Published in: Asian cardiovascular & thoracic annals 2024-11, Vol.32 (8-9), p.475-480
• Main Authors: Rahmat, Budi, Prakoso, Radityo, Simbolon, Rafles PH, Lopolisa, Albert T., Rayhan, Muhammad, Marwali, Eva M.
• Format: Article
• Language: English
• Subjects: Bland White Garland Syndrome - complications; Bland White Garland Syndrome - diagnostic imaging; Bland White Garland Syndrome - physiopathology; Bland White Garland Syndrome - surgery; Child; Coronary Angiography; Delayed Diagnosis; Female; Heart Valve Prosthesis Implantation; Humans; Incidental Findings; Mitral Valve - abnormalities; Mitral Valve - diagnostic imaging; Mitral Valve - physiopathology; Mitral Valve - surgery; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - etiology; Mitral Valve Insufficiency - physiopathology; Mitral Valve Insufficiency - surgery; Severity of Illness Index; Treatment Outcome
• ISSN: 0218-4923; 1816-5370; 1816-5370
• DOI: 10.1177/02184923241295550

Case report A six-year-old child who had undergone cardiac surgery five years ago presented to us with severe mitral valve regurgitation. During her current surgery, the coronary artery was injured during the attempt to release extensive epicardial adhesion, resulting in very poor contractility that prompted a delay in the intended valve repair. The injured coronary vessels were successfully repaired, yet low cardiac output syndrome persisted during perioperative care, necessitating further investigation of the coronary problem. It was later discovered that the patient had anomalous left coronary artery from pulmonary artery (ALCAPA) syndrome. Discussion The presence of severe mitral regurgitation, pulmonary hypertension, and anatomical factors may have contributed to the delayed presentation and diagnosis in this case. The severity of mitral regurgitation and the most likely underlying mechanism indicates a low possibility of recovery following coronary repair alone, warranting the need for concomitant mitral surgery. Coronary and mitral repair were performed in this patient, resulting in a favorable outcome. Conclusions The management of ALCAPA presents unique challenges, especially in cases with delayed diagnosis. Proper diagnosis and tailored surgical approaches are crucial for achieving favorable outcomes in patients with ALCAPA.