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Case Reports
. 2024 Aug 21;29(16):102418.
doi: 10.1016/j.jaccas.2024.102418.

Ventricular Tachycardia Storm in a Young Adult Post-ALCAPA Repair

Sun Young Jeong  1 , Justin Hayase  2 , Jeremy Moore  2 , Aron Bender  2 , Duc Do  2 , Daniel R Sanchez  1 , Jonathan M Doris  3
Affiliations
Case Reports

Ventricular Tachycardia Storm in a Young Adult Post-ALCAPA Repair

Sun Young Jeong et al. JACC Case Rep. .

Abstract

Anomalous left coronary artery to pulmonary artery (ALCAPA) is a leading cause of pediatric myocardial ischemia. This paper presents a case of a young man presenting with ventricular tachycardia storm 18 years after ALCAPA repair. Clinicians should recognize the risk of ventricular tachycardia in this patient population.

Keywords: congenital heart disease; myocardial ischemia; ventricular arrythmia.

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Conflict of interest statement

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Electrocardiograms (A) Monomorphic ventricular tachycardia with atypical right bundle branch block, right inferior axis, and atrioventricular dissociation (best seen in V1), with initial dominant R in aVR, monophasic R waves in V1 and aVR, and rS in V2 to V6. (B) Sinus rhythm and incomplete right bundle branch block.
Figure 2
Figure 2
Cardiac Magnetic Resonance Late gadolinium enhancement is seen in the anterolateral wall of the left ventricle (yellow arrow).
Figure 3
Figure 3
Electroanatomic Voltage Map Voltage maps (NavX) during sinus rhythm at standard scar settings (0.5-1.5 mV) with AP (left) and LAO cranial (right) views showing areas of low voltage along basal superior aspect and along the entire anterolateral left ventricular wall. AP = anterior-posterior; LAO = left anterior oblique.
Figure 4
Figure 4
Intracardiac Electrograms Decremental behavior during pacing seen with premature beats signifies slow conduction and area of interest for ablation.
Figure 5
Figure 5
Cardiac Computed Tomography There was no kinking or strictures of the reimplanted left coronary artery.
See this image and copyright information in PMC

References

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    1. Naimo P.S., Fricke T.A., d'Udekem Y., et al. Surgical intervention for anomalous origin of left coronary artery from the pulmonary artery in children: a long-term follow-up. Ann Thorac Surg. 2016;101(5):1842–1848. - PubMed
    1. Kanoh M., Inai K., Shinohara T., Tomimatsu H., Nakanishi T. Outcomes from anomalous origin of the left coronary artery from the pulmonary artery repair: long-term complications in relation to residual myocardial abnormalities. J Cardiol. 2017;70(5):498–503. - PubMed
    1. Al-Khatib S.M., Stevenson W.G., Ackerman M.J., et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2018;72(14):e91–e220. doi: 10.1016/j.jacc.2017.10.054. - DOI - PubMed

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