Fitzgerald Nicholas, Liava'a Matthew, Gnanappa Ganesh, Ayer Julian
The Heart Centre for Children, The Children's Hospital at Westmead, Corner of Hawkesbury Road and Hainsworth Street, Westmead, New South Wales 2145, Australia.
The University of Sydney Children's Hospital at Westmean Clinical School, Corner of Hawkesbury Road and Hainsworth Street, Westmead, New South Wales 2145, Australia.
Eur Heart J Case Rep. 2025 Jan 20;9(2):ytaf012. doi: 10.1093/ehjcr/ytaf012. eCollection 2025 Feb.
Ischaemic cardiac chest pain and coronary artery abnormalities are uncommon in children. The long-term implications of missed or delayed diagnosis are myocardial ischaemia and risk of sudden cardiac death. Improvement in non-invasive imaging has made diagnosis and surgical planning possible with multi-modal imaging.
A 12-year-old boy with ischaemic chest pain caused by isolation of the left coronary ostium in the context of a dysplastic aortic valve. There was a delay to formal diagnosis. Surgical aortic valve repair resulted in complete resolution of symptoms. Ethics approved (SCHN: CCR2023/5).
Isolation of the left coronary ostium caused by a dysplastic aortic valve (without supravalvar stenosis) is an example of a rare cause of ischaemic chest pain in children. To our knowledge, only 10 paediatric case reports are published in English. In reported cases, presenting features varied from poor feeding and a murmur in infants to chest pain, syncope, or cardiac arrest in adolescents. Historically, angiography during a cardiac catheter procedure was required for diagnosis; however, improvements in non-invasive imaging techniques have resulted in the diagnosis being possible on echocardiography (supported by computed tomography angiography or cardiac magnetic resonance imaging).
缺血性心前区疼痛和冠状动脉异常在儿童中并不常见。漏诊或延迟诊断的长期后果是心肌缺血和心源性猝死风险。无创成像技术的进步使得通过多模态成像进行诊断和手术规划成为可能。
一名12岁男孩，因发育异常的主动脉瓣导致左冠状动脉口孤立而出现缺血性胸痛。诊断出现延迟。手术修复主动脉瓣后症状完全缓解。已获得伦理批准（新南威尔士州临床研究网络：CCR2023/5）。
发育异常的主动脉瓣（无瓣上狭窄）导致的左冠状动脉口孤立是儿童缺血性胸痛的罕见原因之一。据我们所知，仅有10篇英文儿科病例报告发表。在已报道的病例中，临床表现从婴儿期的喂养困难和杂音到青少年期的胸痛、晕厥或心脏骤停不等。历史上，心脏导管检查期间需要进行血管造影来诊断；然而，无创成像技术的进步使得通过超声心动图（计算机断层血管造影或心脏磁共振成像辅助）即可进行诊断。
