Key result
Surgical unroofing after stabilization achieves clinical recovery in pediatric AAOLCA presenting with cardiac arrest.
Why the study?
Anomalous aortic origin of the left coronary artery is a rare congenital coronary anomaly that can present with an acute clinical picture indistinguishable from acute myocarditis despite differing in pathophysiology.
Case Report (n=1)
Anomalous aortic origin of the left coronary artery (AAOLCA) should be considered in the differential diagnosis when pediatric myocarditis presents with atypical features, with surgical unroofing leading to clinical recovery after stabilization.
AAOLCA can mimic acute myocarditis in children; leaves open standardized imaging protocols for this rare entity.
BACKGROUND: Anomalous aortic origin of the left coronary artery (AAOLCA) is a rare congenital coronary anomaly causing myocardial ischemia and sudden cardiac death. Despite differing in pathophysiology from acute myocarditis, AAOLCA can present with a clinically indistinguishable acute picture. CASE SUMMARY: We report an 11-year-old child with no prior cardiac history presenting with fever (40 °C), syncope, cardiac arrest, and cardiogenic shock. Elevated troponin and reduced ejection fraction initially suggested acute myocarditis, which could not be excluded. Atypical features-absent arrhythmia, rapid biomarker normalization, and fluctuating ventricular function-prompted further evaluation. Echocardiography and coronary angiography identified AAOLCA with a hemodynamically significant intramural segment; dynamic ischemia was confirmed during angiography. Surgical unroofing resulted in clinical recovery. CONCLUSIONS: AAOLCA should be considered when pediatric myocarditis presents atypically. Echocardiography is essential. When concurrent myocarditis cannot be excluded, surgical timing should be individualized; here, a period of stabilization preceded definitive repair.
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Bui et al. (2026) conducted a case report in Anomalous aortic origin of the left coronary artery (AAOLCA) presenting as suspected acute myocarditis (n=1). Surgical unroofing was evaluated on Clinical recovery. Surgical unroofing after stabilization resulted in clinical recovery in an 11-year-old child with AAOLCA presenting with 40 °C fever, cardiac arrest, and cardiogenic shock.
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