Anomalous left coronary artery arising from the left pulmonary artery, aortic coarctation, and a large ventricular septal defect.

摘要

We describe a case of large ventricular septal defect (VSD), coarctation of the aorta, anomalous left coronary artery arising from the left pulmonary artery (ALCALPA), and congenital diaphragmatic hernia that was successfully managed surgically. Literature search revealed no report of a similar condition.A baby girl was found to have a right-sided diaphragmatic hernia antenatally. Fetal cardiac ultrasonography suggested perimembra-nous VSD. These diagnoses were confirmed postnatally, and the hernia was repaired. In addition to the VSD, the baby was found to have an aortic coarctation and pulmonary hypertension (PHT) out of proportion to the size of the VSD. Medical treatment failed to control symptoms of respiratory distress, and surgical intervention to repair the VSD and coarctation was planned. Preoperative cardiac catheterization was performed to assess PHT and to confirm the severity of the coarctation. This confirmed a large per-imembranous VSD with large left-to-right shunt and balanced ventricular pressures, moderate coarctation of the aorta with isth-mic hypoplasia, and the unexpected finding of an ALCALPA (Figures 1 and 2); this last finding had not been identified echo-cardiographically. The baby also had a patent foramen ovale and small patent ductus arteriosus. There was no coexisting mitral regurgitation.