Hyperechoic papillary muscle: A sign of ALCAPA in the presence of left-to-right shunts
A 10-month-old female child with failure to thrive was diagnosed to have a large atrial septal defect (ASD) with deficient rims and large patent ductus arteriosus (PDA) and was referred for management. Echocardiography showed normal left ventricular (LV) function with dilated right atrium and right...
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Wolters Kluwer Medknow Publications
2024-12-01
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| Series: | Journal of Clinical and Scientific Research |
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| Online Access: | https://journals.lww.com/10.4103/jcsr.jcsr_12_23 |
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| author | Thanigai Arasu T Komal Krishnan Ganapathy Subramaniam Dhruva Sharma N. Srinath Reddy |
| author_facet | Thanigai Arasu T Komal Krishnan Ganapathy Subramaniam Dhruva Sharma N. Srinath Reddy |
| author_sort | Thanigai Arasu |
| collection | DOAJ |
| description | A 10-month-old female child with failure to thrive was diagnosed to have a large atrial septal defect (ASD) with deficient rims and large patent ductus arteriosus (PDA) and was referred for management. Echocardiography showed normal left ventricular (LV) function with dilated right atrium and right ventricle; the only suspicious finding was that of the hyperechoic papillary muscle. After the PDA ligation, the ASD was closed with an autologous pericardial patch when the aortic cross-clamp was released, the rhythm returned and trans-oesophageal echocardiography showed severe LV dysfunction. While still on the pump, the PA was opened, and the coronary ostia were identified as arising from the non-facing sinus. Coronary reimplantation was done, and then, the patient could be weaned off cardiopulmonary bypass uneventfully, the child was shifted to the intensive care unit with minimal inotropic support and was discharged by the 7th day with normal ventricular function. The presence of an anomalous coronary artery can be masked by the large left-to-right shunts, resulting in PA hypertension. Anomalous left coronary artery from the right pulmonary artery (ALCAPA) should be suspected in the presence of hyperechoic papillary muscles, which could be a sign of papillary muscle ischaemia. ALCAPA can be missed in the presence of significant left-to-right shunts, which increases the pulmonary artery (PA) pressures and the oxygenation of pulmonary arterial blood. We present one such case with large ASD and PDA, with normal LV function and no mitral regurgitation, with the only indicator being hyperechoic papillary muscles. |
| format | Article |
| id | doaj-art-8a4fea4ad2b04560acbd9e4b28db1145 |
| institution | Kabale University |
| issn | 2277-5706 2277-8357 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Clinical and Scientific Research |
| spelling | doaj-art-8a4fea4ad2b04560acbd9e4b28db11452025-01-11T09:47:19ZengWolters Kluwer Medknow PublicationsJournal of Clinical and Scientific Research2277-57062277-83572024-12-0113Suppl 1S61S6410.4103/jcsr.jcsr_12_23Hyperechoic papillary muscle: A sign of ALCAPA in the presence of left-to-right shuntsThanigai ArasuT KomalKrishnan Ganapathy SubramaniamDhruva SharmaN. Srinath ReddyA 10-month-old female child with failure to thrive was diagnosed to have a large atrial septal defect (ASD) with deficient rims and large patent ductus arteriosus (PDA) and was referred for management. Echocardiography showed normal left ventricular (LV) function with dilated right atrium and right ventricle; the only suspicious finding was that of the hyperechoic papillary muscle. After the PDA ligation, the ASD was closed with an autologous pericardial patch when the aortic cross-clamp was released, the rhythm returned and trans-oesophageal echocardiography showed severe LV dysfunction. While still on the pump, the PA was opened, and the coronary ostia were identified as arising from the non-facing sinus. Coronary reimplantation was done, and then, the patient could be weaned off cardiopulmonary bypass uneventfully, the child was shifted to the intensive care unit with minimal inotropic support and was discharged by the 7th day with normal ventricular function. The presence of an anomalous coronary artery can be masked by the large left-to-right shunts, resulting in PA hypertension. Anomalous left coronary artery from the right pulmonary artery (ALCAPA) should be suspected in the presence of hyperechoic papillary muscles, which could be a sign of papillary muscle ischaemia. ALCAPA can be missed in the presence of significant left-to-right shunts, which increases the pulmonary artery (PA) pressures and the oxygenation of pulmonary arterial blood. We present one such case with large ASD and PDA, with normal LV function and no mitral regurgitation, with the only indicator being hyperechoic papillary muscles.https://journals.lww.com/10.4103/jcsr.jcsr_12_23alcapaasdhyperechoic papillary musclel-r shunt |
| spellingShingle | Thanigai Arasu T Komal Krishnan Ganapathy Subramaniam Dhruva Sharma N. Srinath Reddy Hyperechoic papillary muscle: A sign of ALCAPA in the presence of left-to-right shunts Journal of Clinical and Scientific Research alcapa asd hyperechoic papillary muscle l-r shunt |
| title | Hyperechoic papillary muscle: A sign of ALCAPA in the presence of left-to-right shunts |
| title_full | Hyperechoic papillary muscle: A sign of ALCAPA in the presence of left-to-right shunts |
| title_fullStr | Hyperechoic papillary muscle: A sign of ALCAPA in the presence of left-to-right shunts |
| title_full_unstemmed | Hyperechoic papillary muscle: A sign of ALCAPA in the presence of left-to-right shunts |
| title_short | Hyperechoic papillary muscle: A sign of ALCAPA in the presence of left-to-right shunts |
| title_sort | hyperechoic papillary muscle a sign of alcapa in the presence of left to right shunts |
| topic | alcapa asd hyperechoic papillary muscle l-r shunt |
| url | https://journals.lww.com/10.4103/jcsr.jcsr_12_23 |
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