[Anomalous origin of the left anterior descending coronary artery from the pulmonary artery associated with other anomalies: a case report].

A two-month-old boy with anomalous origin of the left anterior descending coronary artery (AOLAD), aortic stenosis (AS), coarctation of the aorta (CoA) and patent ductus arteriosus (PDA) is reported. Tachypnea was observed since birth. When he arrived at our hospital, congestive heart failure, cyanosis of his lower extremities and weak femoral pulses were observed. Radiography revealed cardiomegaly and pulmonary congestion. ECG showed low voltage in all leads, ST elevation in leads II, aVF, V5,6 and abnormal Q waves in V5,6. The tentative diagnosis by two-dimensional echocardiography (2DE) was AS, CoA, PDA, pulmonary hypertension and pericardial effusion. The abnormal coronary artery was visualized as originating from the left anterior wall of the pulmonary artery, coursing between the pulmonary artery and left atrial appendage. A definitive diagnosis of AOLAD were made by angiography. Aortic reconstruction using an artificial graft for CoA and PDA ligation was performed first. He died of myocardial infarction while waiting for his second operation for AOLAD and AS. Autopsy confirmed the aforementioned diagnoses as well as old and recent infarction of the myocardium. AOLAD is a rare congenital malformation, only six cases of which have been reported. Moreover, AOLAD complicated by other anomalies had not been previously reported. This is the first such reported case.