Out-of-Hospital Cardiac Arrest as the First Manifestation of ALCAPA in a 9-Week-Old Infant: Survival to Discharge After Emergency Repair and VA-ECMO
- 1Department of Clinical and Experimental Pathology, Institute of Medical Sciences, Jan Kochanowski University, 25-516 Kielce, Poland
- 22nd Department of Obstetrics and Gynecology, Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
- 3Department of Gynecology and Obstetrics, Institute of Medical Sciences, Jan Kochanowski University, 25-516 Kielce, Poland
Abstract
Background and Clinical Significance: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) usually presents with heart failure at 2–3 months of age; cardiac arrest as the first manifestation is rare and often recognized only at autopsy. Case Presentation: A previously healthy girl collapsed at home at 65 days of age. After dispatcher-assisted parental resuscitation, the emergency team found asystole and achieved return of spontaneous circulation after approximately 4 min of professional resuscitation; the total low-flow time was not recorded. She was in cardiogenic shock (left ventricular ejection fraction 19.8%, high-sensitivity troponin T 2620 ng/L) with acute kidney injury and coagulopathy consistent with disseminated intravascular coagulation. Echocardiography showed a dilated right coronary artery and no flow from the aorta into the left coronary artery. Emergency repair on day 1 was followed by venoarterial extracorporeal membrane oxygenation (VA-ECMO) for 4 days and continuous renal replacement therapy. The Simpson ejection fraction reached about 50% by day 9, fell to 37–40% during respiratory deterioration and was 45–50% on day 27; mitral regurgitation, graded as massive during VA-ECMO, regressed to trace without valve surgery. She was discharged on day 42 with impaired diastolic indices; no formal neurological assessment was documented. Conclusions: ALCAPA should be considered in every infant with unexplained cardiac arrest, and post-resuscitation echocardiography should assess the coronary origins. Emergency repair with VA-ECMO can achieve survival to discharge despite multiorgan failure, but long-term cardiac and neurodevelopmental follow-up is required.
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BibTeX
@article{wrobel2026outofhospital,
title = {{Out-of-Hospital Cardiac Arrest as the First Manifestation of ALCAPA in a 9-Week-Old Infant: Survival to Discharge After Emergency Repair and VA-ECMO}},
author = {Grzegorz Wróbel and Jakub Gruszka and Piotr Lewitowicz and Olga Adamczyk-Gruszka},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15218476},
url = {https://www.mdpi.com/2077-0383/15/21/8476},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Out-of-Hospital Cardiac Arrest as the First Manifestation of ALCAPA in a 9-Week-Old Infant: Survival to Discharge After Emergency Repair and VA-ECMO
AU - Grzegorz Wróbel
AU - Jakub Gruszka
AU - Piotr Lewitowicz
AU - Olga Adamczyk-Gruszka
PY - 2026
DA - 2026/10/30
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218476
UR - https://www.mdpi.com/2077-0383/15/21/8476
AB - Background and Clinical Significance: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) usually presents with heart failure at 2–3 months of age; cardiac arrest as the first manifestation is rare and often recognized only at autopsy. Case Presentation: A previously healthy girl collapsed at home at 65 days of age. After dispatcher-assisted parental resuscitation, the emergency team found asystole and achieved return of spontaneous circulation after approximately 4 min of professional resuscitation; the total low-flow time was not recorded. She was in cardiogenic shock (left ventricular ejection fraction 19.8%, high-sensitivity troponin T 2620 ng/L) with acute kidney injury and coagulopathy consistent with disseminated intravascular coagulation. Echocardiography showed a dilated right coronary artery and no flow from the aorta into the left coronary artery. Emergency repair on day 1 was followed by venoarterial extracorporeal membrane oxygenation (VA-ECMO) for 4 days and continuous renal replacement therapy. The Simpson ejection fraction reached about 50% by day 9, fell to 37–40% during respiratory deterioration and was 45–50% on day 27; mitral regurgitation, graded as massive during VA-ECMO, regressed to trace without valve surgery. She was discharged on day 42 with impaired diastolic indices; no formal neurological assessment was documented. Conclusions: ALCAPA should be considered in every infant with unexplained cardiac arrest, and post-resuscitation echocardiography should assess the coronary origins. Emergency repair with VA-ECMO can achieve survival to discharge despite multiorgan failure, but long-term cardiac and neurodevelopmental follow-up is required.
SN - 2077-0383
ER -