Naissance Anormale Du Tronc Coronaire Gauche A Partir De L’artere Pulmonaire : à propos d’un cas (Anomalous Left Coronary Artery From Pulmonary Artery: about a case)

Abstract

Anomalous left coronary artery from pulmonary artery ALCAPA, is a rare congenital heart disease. It affects one child in 300,000 births. It causes myocardial ischemia leading to impaired left ventricle systolic function and signs of left heart failure. Several authors have already reported cases of ALCAPA. We are reporting for the first time a case seen in Madagascar. This is a Franco-Malagasy child aged 4 months and 3 weeks, hospitalized at the Mother and Child University Hospital of Tsaralalana for progressively worsening dyspnea. At entry, the infant presented with cyanosis and signs of cardiogenic shock: hypotension, oligoanuria and cold extremities. The physical examination essentially found pulmonary rales, a 2/6 systolic murmur of mitral insufficiency and hepatomegaly. Chest X-ray showed significant cardiomegaly. The electrocardiogram found a Q wave of necrosis in DI, AVL and V2 to V6. The echocardiogram coupled with Doppler performed at the Soavinandriana Hospital concluded that the left coronary artery was connected to the pulmonary artery. The progression after 6 days in hospital was marked by the disappearance of signs of shock and dyspnea after treatment with Dobutamine, diuretics and Salbutamol. The child was proposed for a surgical cure, the gold standard of treatment for ALCAPA.