An unusual cause of cardiac arrest in a young infant

TL;DR

A rare heart condition caused cardiac arrest in a young infant, but timely diagnosis and surgery saved the child's life.

Contribution

Highlights a rare and critical presentation of AAOCA in infants requiring surgical and pacing interventions.

Findings

AAOCA can present with cardiac arrest in infants, necessitating urgent surgical and pacemaker interventions.

Successful postoperative recovery was achieved with no symptoms at nine-month follow-up.

Complete atrioventricular block persisted, requiring ongoing pacing.

Abstract

Anomalous aortic origin of a coronary artery from the inappropriate sinus of Valsalva (AAOCA) is a rare congenital heart lesion. It is uncommon for patients with AAOCA to present with severe symptoms at a very young age.

We describe a very rare but critical presentation in a young infant with AAOCA that requires surgical repair and pacemaker placement. A three-month-old infant was referred because of syncope. Cardiac arrest occurred shortly after admission. The electrocardiogram indicated a complete atrioventricular block and a transvenous temporary pacemaker was implanted. A further coronary computed tomographic angiography (CTA) showed the anomalous origin of the right coronary artery from the left sinus of Valsalva. Coronary artery unroofing was performed due to an interarterial course with the intramural component, and a permanent epicardial pacemaker was implanted. The postoperative recovery was uneventful, and this patient was thriving and asymptomatic at the nine-month follow-up. However, the electrocardiogram still indicated a complete pacing rhythm.

By timely diagnosis and treatment, this patient is successfully rescued. Although rare, AAOCA may be fatal even in infants.

The online version contains supplementary material available at 10.1186/s12872-024-04028-1.

Figures