Summary Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA, or Bland–White–Garland syndrome) is a rare congenital anomaly associated with a high risk of ischaemic cardiomyopathy and sudden cardiac death. Non‐cardiac surgery in patients with uncorrected anomaly is exceedingly rare and standardised peri‐operative risk models are lacking. This case report highlights the complex physiological considerations and tailored anaesthetic management of a 13‐year‐old girl with uncorrected ALCAPA undergoing general anaesthesia for dental extractions. Pre‐operative echocardiography demonstrated left ventricular dilatation (52.2 mm) with a preserved ejection fraction (68%) and mild mitral regurgitation. Cardiac magnetic resonance imaging revealed extensive subendocardial scarring and inducible stress perfusion defects, indicating ongoing ischaemic and arrhythmogenic risk. Following a multidisciplinary consensus, the procedure was performed under strict haemodynamic control. General anaesthesia was carefully titrated to maintain the balance between myocardial oxygen supply and demand, and to prevent the exacerbation of coronary steal, with advanced ischaemia monitoring and immediate defibrillator availability. The patient remained haemodynamically stable throughout the peri‐operative period. This case demonstrates that by integrating detailed anatomic and functional imaging data, anaesthetic strategies can be precisely tailored to manage the severe physiological vulnerabilities of patients with uncorrected ALCAPA.
Tong et al. (Thu,) studied this question.