Hemopericardium and cardiac tamponade as presenting findings of anomalous left coronary artery syndrome complicated by transmural myocardial infarction

Imaging characteristics of anomalous left coronary artery from the pulmonary artery

SUMMARY

The authors report the imaging characteristics of the anomalous origin of the left coronary artery from the pulmonary artery in a 6 1/2-month-old male infant using electrocardiography, echocardiography, angiography, and electron-beam computed tomography. The patient presented with tachycardia, prolonged and interrupted feeding, failure to thrive, and myocardial infarction, and after diagnosis of the anomalous origin of the left coronary artery, survived the reimplantation of the left coronary artery directly to the ascending aorta. When reviewed 7 months after surgery, echocardiography showed improved left ventricular function and surface electrocardiography showed regression of pathologic Q waves in leads I, V 4, V 5, and V 6.

Incipient left ventricular rupture complicating anomalous left coronary artery

A 4-month-old girl presented with 2 weeks of symptoms and physical signs of heart failure. Echocardiography demonstrated marked left ventricular dilation, thinning of the myocardium with anterolateral akinesis, mitral regurgitation, a moderate pericardial collection, and an anomalous left coronary artery from the pulmonary artery. At operation there was a tense hemopericardium and a site of imminent rupture through a transmural anterior infarction. The anomalous artery was reimplanted in the ascending aorta, and an extensive infarct resection and ventricular repair performed. Support with a left ventricular assist device was required for 3 days, but the infant subsequently made a satisfactory recovery. Left ventricular rupture is a very rare complication of this lesion, but should be considered if there is evidence of a pericardial collection.