Mirella Petrisano, Maria Scavone, Costantino Smaldone, Aurora Dinatale, Giambattista Gallicchio, Giorgio Madonna, Daniela Concolino, Antonio Sisto, Simona Pesce
Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital disease in which the left coronary artery arises from the main pulmonary artery resulting in myocardial dysfunction. Myocardial ischemia in infancy results in nonspecific clinical symptoms, and therefore imaging performs a crucial role in the diagnostic process. Echocardiograms may reveal the anomaly, even if there are indirect radiological or ECG signs. Prompt surgical intervention to reestablish a two–coronary artery circulation allows gradual myocardial recovery nevertheless, the mortality rate from this condition is dramatically high if it is not recognized early. We present the case of a newborn referred to the neonatal intensive care unit on the 3rd day of life because of sudden skin marbling and tachycardia. The baby underwent several diagnostic tests which detected ALCAPA. He received surgical correction of the condition and started extracorporeal membrane oxygenation (ECMO), despite this he become hemodynamically unstable and expired.