Hybrid Transaortic Emergency Stenting of an Obstructed Left Main Coronary Artery in an Infant on ECMO and Ongoing Myocardial Infarction.

We report hybrid transaortic coronary intervention for severe stenosis of a left main coronary artery in a 3-month-old 2.9-kg female, following surgical repair of an anomalous left coronary artery from the pulmonary artery. The patient experienced myocardial ischaemia with severe left ventricular dysfunction, necessitating extracorporeal membrane oxygenation. Surgical reoperation was deemed of high-risk. After 2 failed attempts of percutaneous coronary interventions, hybrid transaortic access of the left main coronary artery was successfully performed. Because of immediate recoil after balloon angioplasty, a drug-eluting stent was implanted. The patient dramatically improved, with ECMO discontinuation, extubation, and recovery of an almost normal left-ventricular function. She was discharged home but experienced in-stent restenosis with suboptimal compliance to antiplatelet treatment. She remained clinically stable and awaiting bypass coronary graft. Such procedure with LMCA stenting in small infants is feasible and successful. It should be limited to life-saving situations, when no other treatment option is available.