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Ann Thorac Surg 1999;67:254-256
© 1999 The Society of Thoracic Surgeons

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Case Reports

Incipient left ventricular rupture complicating anomalous left coronary artery

^a Victorian Pediatric Cardiac Surgery Unit and Department of Cardiology, Royal Children’s Hospital, Melbourne, Victoria, Australia

Accepted for publication June 29, 1998.

Address reprint requests to Dr Cochrane, Victorian Pediatric Cardiac Surgery Unit, Royal Children’s Hospital, Flemington Rd, Parkville, 3052, Victoria, Australia

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.

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