Page 26 - Journal of Structural Heart Disease Volume 3, Issue 5

Case Report
Journal of Structural Heart Disease, October 2017, Volume 3, Issue 5:152-156
DOI: https://doi.org/10.12945/j.jshd.2017.021.17
False Negative Echocardiography in an
Received: April 27, 2017 Accepted: June 5, 2017 Published online: October 2017
Adolescent with Anomalous Left Main Coronary
Artery Origin Presenting with Cardiac Arrest
Kirstine N. Hansen, BMSc1*, Jeanette K. Petersen, MD2, Knud Nørregaard Hansen, MD1, Lisette O. Jensen, MD, PhD, DMSci1
1 Department of Cardiology, Odense University Hospital, Odense, Denmark 2 Department of Pathology, Odense University Hospital, Odense, Denmark
Abstract
A 13-year-old boy with attention de cit hyperactivity disorder treated with atomoxetin experienced cardiac collapse after physical exercise with exposure to cold water. After resuscitation using a mechanical chest compression device and treatment with extracorpo- real heart lung assist, coronary angiography showed abnormal origin of the left main coronary artery and severe stenosis, which was stented. In early childhood, transthoracic echocardiography was interpreted as showing normal origins and courses of coronary ar- teries. The patient died, and autopsy con rmed the abnormal origin of the left main coronary artery cours- ing between the pulmonary artery and aorta. This case demonstrates that two-dimensional transthoracic echocardiography can lead to false negative diagnosis when assessing the origin of the left coronary artery. Thus, echocardiography may be inferior to computed tomography or magnetic resonance imaging in assess- ing coronary artery abnormalities.
Copyright © 2017 Science International Corp.
Key Words
Anomalous coronary artery • Extracorporeal heart lung assist • Heart attack • Echocardiogram
Introduction
Anomalous origin of the left main coronary artery from the right sinus or anomalous origin of the right coronary artery from the left sinus are associated with
ischemia and sudden death. These abnormalities are often asymptomatic and are mostly diagnosed post-mortem. Although echocardiography can be used to diagnose coronary abnormalities, its interpre- tation can result in false negatives [1]. These two ab- normalities have a combined incidence ranging from 0.2% in autopsy studies to 1.2% in coronary angiogra- phy studies [2]. A left coronary artery running between the aorta and pulmonary artery has been linked to fa- tal arrhythmias and sudden death, especially in young people and usually during or after exercise [3].
Case Presentation
A 13-year-old boy experienced severe chest pain while swimming. He had a known history of attention de cit hyperactivity disorder treated with atomoxe- tin for several years but no history of chest pain. When paramedics arrived, the patient was awake with severe chest pain. Electrocardiography showed extensive ST segment elevations in the anterior leads and left bundle branch block. The patient went into cardiac arrest with pulseless electrical activity, and cardiopulmonary resus- citation therapy was initiated with a LUCAS mechanical chest compression device. The patient was transferred by helicopter to the nearest heart center with 24/7 in- vasive cardiology facilities. During transportation, the patient received adrenalin several times. After 90 min, he arrived at the catheterization laboratory uncon- scious and intubated. Blood samples revealed severe
* Corresponding Author:
Kirstine N. Hansen, BMSc
Department of Cardiology
Odense University Hospital
Sdr. Boulevard 29, 5000 Odense C, Denmark
Tel.: +45 6177 2891; Fax: +45 6312 1730; E-Mail: kihan12@student.sdu.dk
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2017 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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