PMC8426061_01
Post-resuscitation electrocardiogram.
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fig1
T-waves and ventricular bigeminy (Figure 1). Transthoracic echocardiography revealed an undilated left ventricle with moderately impaired systolic function and mild mitral regurgitation. The left coronary artery was not seen at the left aortic sinus.
Computed tomography. Three-dimensional multiplanar and volume rendering reconstructions. (a, b) Left coronary artery connected to the pulmonary trunk; (c, d) right coronary artery (and its marginal branch) connected to the aorta.
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CT scan showed the presence of an ALCAPA with a compensatory dilated right coronary artery (RCA) (Figure 2). Coronary angiography demonstrated the left-to-right shunt, from the normally implanted RCA towards the left coronary artery and into the pulmonary trunk, through an important network of collaterals (Figure 3).
Coronary angiogram. Dilated right coronary artery with left-to-right shunt towards the left coronary artery connected to the pulmonary trunk; note the important collateral network.
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fig3
CT scan showed the presence of an ALCAPA with a compensatory dilated right coronary artery (RCA) (Figure 2). Coronary angiography demonstrated the left-to-right shunt, from the normally implanted RCA towards the left coronary artery and into the pulmonary trunk, through an important network of collaterals (Figure 3).
Cardiac MRI:short-axis views. (a) Cine acquisition: note the hypertrophy of the anterolateral papillary muscle; (b) phase-sensitive inversion recovery (PSIR) sequence: late gadolinium enhancement (LGE) of the anterolateral papillary muscle.
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MRI showed an undilated left ventricle (end-diastolic left ventricular volume 82 mL/m2) with preserved systolic function (ejection fraction 63%). Morphological analysis and phase-sensitive inversion recovery sequences found hypertrophy of the anterolateral papillary muscle with late gadolinium enhancement, suggesting areas of subendocardial cicatricial fibrosis (Figure 4).