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. 2013 Sep 16:14:370-2.
doi: 10.12659/AJCR.889112. eCollection 2013.

Bland-White-Garland syndrome - a rare and serious cause of failure to thrive

Agnieszka Szmigielska  1 , Maria Roszkowska-Blaim, Małgorzata Gołąbek-Dylewska, Agnieszka Tomik, Michał Brzewski, Bożena Werner
Affiliations

Bland-White-Garland syndrome - a rare and serious cause of failure to thrive

Agnieszka Szmigielska et al. Am J Case Rep. .

Abstract

Patient: Male, 0 FINAL DIAGNOSIS: Bland-White-Garland syndrome Symptoms: Cardiomegaly, feeding problems Medication: - Clinical Procedure: Reimplantation of the left coronary artery to the aorta Specialty: Pediatrics and Neonatology.

Objective: Rare disease.

Background: Bland-White-Garland syndrome (BWGS) is a very rare disease characterized by anomalous origin of the left coronary artery from the pulmonary trunk (ALCAPA). WBGS affects 1 in every 300 000 live births. Children typically present with dyspnea, pallor, and failure to thrive. Without surgical repair, most of these children die during the first months of life.

Case report: This case report describes 3-month-old boy admitted to the hospital because of feeding problems. The boy was born at term, with birth weight 3200 g, and was 10 points in Apgar score. He was breast-fed from birth. From the seventh week of age, his mother observed his increasing difficulties with feeding. Physical examination revealed pale skin, diminished heart sounds, tachycardia, cardiomegaly, and hepatomegaly. Results of urine and blood tests and ultrasonography of the central nervous system and abdomen were normal. The chest radiography showed cardiomegaly and electrocardiogram revealed anterolateral myocardial infarction. On echocardiography, an anomalous left coronary artery arising from the pulmonary artery was found. The life-saving treatment of choice was immediate surgical reimplantation of the left coronary artery to the aorta.

Conclusions: Children with congenital heart disease are often prone to malnutrition, but in rare cases failure to thrive and breast-feeding problems can be the first symptoms of life-threatening diseases like myocardial infarction secondary to Bland-White-Garland syndrome (BWGS).

Keywords: ALCAPA failure to thrive; Bland-White-Garland syndrome; infant; myocardial infarction.

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Figures

Figure 1.
Figure 1.
ECG: Deep Q waves and T waves inversions in leads I, avL and deep Q waves with ST elevation in the left precordial leads (V5–V6). Signs of anterolateral myocardial infarction.
Figure 2.
Figure 2.
2D-ECHO. Parasternal short axis view at the level of the great vessels. Anomalous left coronary artery originating from the pulmonary trunk.
Figure 3.
Figure 3.
Chest X-ray showing significant cardiomegaly.
See this image and copyright information in PMC

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