# Advanced Echocardiography Assessment in the Management of Alcapa Syndrome: Case Report

## TL;DR

This case report shows how advanced echocardiography can detect heart muscle issues in a rare infant condition before and after surgery.

## Contribution

The study demonstrates the use of speckle-tracking echocardiography to detect regional myocardial dysfunction in ALCAPA patients.

## Key findings

- Speckle-tracking echocardiography identified preoperative LV contraction issues in LCA and RCA-supplied regions.
- Postoperative analysis showed persistent impairment in LCA-supplied territories despite improved ejection fraction.
- Speckle-tracking is more sensitive than conventional echocardiography for detecting regional LV dysfunction in ALCAPA.

## Abstract

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare and potentially life-threatening condition affecting infants that requires immediate corrective surgery to restore blood flow to the myocardium. We present a case of an infant with ALCAPA and severe heart failure. What sets this case apart is the utilization of speckle-tracking echocardiography as a non-invasive method for assessing global and regional myocardial function before and after surgical intervention. Our preoperative analysis revealed compromised contraction in specific areas of the left ventricle (LV), in the regions that were supplied by both the left coronary artery (LCA) and the right coronary artery (RCA). Interestingly, despite an increase in ejection fraction (EF) measured by conventional echocardiography, the postoperative speckle-tracking analysis revealed persistent impairment in the anterior territories supplied by LCA, highlighting the potential of this technique in identifying myocardial abnormalities during postoperative follow-up. In conclusion, speckle-tracking echocardiography may be a valuable tool for identifying subtle myocardial changes in ALCAPA patients with a higher sensitivity in detecting regional left ventricular (LV) dysfunction compared to conventional echocardiography.