Myocardial calcification revealed by postmortem computed tomography in a case of infantile myocardial ischemia caused by anomalous origin of the left coronary artery from the pulmonary artery.

Bland-Garland-White syndrome, or an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), is a rare congenital coronary anomaly that can cause myocardial ischemia, congestive heart failure, and sudden death. In this study, we aimed to present a case of sudden infant death caused by ALCAPA. Postmortem computed tomography (PMCT) showed a collapsed left lung, enlarged heart volume, and severe calcification of the left ventricular papillary muscles and posterior left ventricular wall. Macroscopic examination during the autopsy revealed marked cardiac hypertrophy and an anomalous left coronary artery originating from the pulmonary artery. Furthermore, microscopic examination showed significant myocardial fibrosis with severe left ventricular calcification. Histological findings revealed features of acute-on-chronic myocardial ischemia, including myocytolysis around fibrotic and calcified areas, contraction-band necrosis, and a characteristic wavy cardiomyocyte pattern. In this case, we suggest that localized myocardial calcification detected by PMCT, particularly following three-dimensional visualization, may be useful for the postmortem assessment of ALCAPA and other causes of chronic myocardial ischemia in infants.