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Fatal coronary artery anomaly presenting as bronchiolitis

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Abstract

During winter outbreaks of respiratory syncytial virus bronchiolitis from 2002 to 2004, three infants presented with a presumptive diagnosis of lower respiratory tract infection and wheezing. The clinical condition in two cases was rapidly progressive and precipitated into intractable shock; clinical and instrumental examinations revealed a cardiac origin of their illness. A subacute presentation permitted a cardiological assessment and a proper treatment in the third infant. An abnormal origin of the left coronary artery from the pulmonary trunk was demonstrated in all cases. The concurrent acute airway infection had a catastrophic effect on the underlying cardiovascular anomaly leading to refractory cardiogenic shock and death. Conclusion:Admission chest X-ray film and arterial gas analysis can raise the suspicion of cardiac involvement when treating a severe wheezing episode in young infants. Paediatric cardiological evaluation with two-dimensional echocardiography may eventually reveal this rare condition, whereas cardiac catheterisation with aortography remains the standard means of diagnosis.

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Abbreviations

CXR :

chest x-ray film

ECM :

external cardiac massage

LCA :

left coronary artery

LV :

left ventricle

RSV :

respiratory syncytial virus

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Authors and Affiliations

  1. Paediatric Intensive Care Unit, Policlinico A. Gemelli, L.go A. Gemelli 8, 00168 , Rome, Italy

    Marco Piastra, Giancarlo Polidori, Elena Caresta, Silvia Pulitanò & Antonio Chiaretti

  2. Neonatal Intensive Care Unit, Catholic University Medical School, Rome, Italy

    Maria Pia De Carolis & Alessia Tempera

  3. Department of Paediatric Infectious Diseases, Catholic University Medical School, Rome, Italy

    Piero Valentini

  4. Department of Paediatric Cardiology, Catholic University Medical School, Rome, Italy

    Gabriella De Rosa

Authors
  1. Marco Piastra
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  2. Giancarlo Polidori
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  3. Maria Pia De Carolis
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  4. Alessia Tempera
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  5. Elena Caresta
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  6. Silvia Pulitanò
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  7. Antonio Chiaretti
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  8. Piero Valentini
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  9. Gabriella De Rosa
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Correspondence to Marco Piastra.

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Piastra, M., Polidori, G., De Carolis, M.P. et al. Fatal coronary artery anomaly presenting as bronchiolitis. Eur J Pediatr 164, 515–519 (2005). https://doi.org/10.1007/s00431-005-1684-1

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  • DOI: https://doi.org/10.1007/s00431-005-1684-1

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