Incipient left ventricular rupture complicating anomalous left coronary artery

A 4-month-old girl presented with 2 weeks of symptoms and physical signs of heart failure. Echocardiography demonstrated marked left ventricular dilat ion, thinning of the myocardium with anterolateral akinesis, mitral regurgi tation, a moderate pericardial collection, and an anomalous left coronary a rtery from the pulmonary artery. At operation there was a tense hemopericar dium and a site of imminent rupture through a transmural anterior infarctio n. The anomalous artery was reimplanted in the ascending aorta, and an exte nsive infarct resection and ventricular repair performed. Support with a le ft ventricular assist device was required for 3 days, but the infant subseq uently made a satisfactory recovery. Left ventricular rupture is a very rar e complication of this lesion, but should be considered if there is evidenc e of a pericardial collection. (Ann Thorac Surg 1999;67:254-6) (C) 1999 by The Society of Thoracic Surgeons.