A post-myocardial infarction magnetic resonance imaging scan of a seven-year-old child with reimplantation of an anomalous origin of the left main coronary artery from the pulmonary artery
Abstract
Anomalous distance of the left coronary artery from the lung is a rare congenital heart defect. The prevalence of the Czech population is about 0.01 per 1,000 live births (1) Of all heart defects, the incidence is 0.22%.
It occurs mainly in isolation or is less often associated with other defects (aortopulmonary window, arterial trunctus, ventricular septal defect). It usually recedes from the left pulmonary sinus.
As the pressure in the pulmonary artery decreases after birth, the flow in the left coronary artery reverses. There is a left-right short circuit, which is not significant, but there is insufficient perfusion of the myocardium with oxygenated blood.
This can result in a myocardial infarction. More than 80% of children used to die in the first year of life.
Currently, this defect is an indication for urgent surgery, usually reimplantation of the left coronary artery into the aorta. Rarely, acquired stenosis of the left coronary artery may occur after reimplantation.
In the presented patient, the congenital anomalous distance of the left coronary artery from the lung was diagnosed at the age of three months and a reimplantation of the left coronary artery into the aorta was performed immediately. Coronary angiography was performed for persistent left ventricular dysfunction with a spike aneurysm and stenosis of the left coronary artery trunk was detected.
Six years after the operation, coronary angiography was performed with the finding of closure of the left coronary artery trunk and good collateral circulation between the basin of the right and left coronary arteries. Echocardiography revealed a disorder of the kinetics of the apical part of the lateral wall of the left ventricle and tip (Figure 1).
Due to the operation under consideration (coronary artery bypass resection of the left ventricular aneurysm), magnetic resonance imaging was recommended. Magnetic resonance imaging of the heart requires good patient cooperation with the need to repeatedly hold the breath for 10-20 seconds.
When examining children, when their cooperation cannot be expected, it is often necessary to introduce the patient under general anesthesia. Thus, the examination was synchronized with both the ECG and the breath.
Although the images suffer from certain movement artifacts, the examination was fully diagnostic.