[New coronavirus infection as a provoking factor for the clinical manifestation of Bland-White-Garland syndrome (case report)].

BACKGROUND

A congenital malformation in the form of an abnormal origin of the left coronary artery from the pulmonary artery leads to the phenomenon of stealing the coronary arteries with a shunt from left to right, causing aberrant left ventricular perfusion. 9 out of 10 children die before reaching the age of one without surgery due to cardiac ischemia, infarction, or congestive heart failure secondary to mitral regurgitation. Some of them survive to a later age thanks to an adequate collateral blood supply through the entrapment of the right coronary artery.

MATERIAL AND

METHODS

The article presents a rare case of Bland-White-Garland syndrome manifestation in a woman aged 43 years.

RESULTS

The angina clinic developed after a coronavirus infection, and was provoked by a constant tachycardia at rest of 90-100 beats per minute, aggravated by exercise. ECG Holter monitoring revealed episodes of severe ST-T depression. On the electrocardiogram - signs of focal cicatricial changes in the anterior septal and high lateral myocardium. Echocardioscopy established that the left coronary artery does not originate from the aorta, but from the pulmonary artery. Detection of a zone of reduced contractility of the myocardium of the left ventricle. A decrease in systolic function of the left ventricle was found (ejection fraction 48-50%). Spiral computed tomographic coronary angiography also confirmed the presence of this anomaly, an increase in the diameter of the left coronary artery up to 5 mm. The diameter of the right coronary artery was also increased to 8 mm. Multiple tortuous collaterals between the left and right coronary systems were revealed. Invasive coronary angiography confirmed the presence of this anomaly. An operation was performed: an anastomosis was made between the aorta and the left coronary artery in an end-to-side manner. The trunk of the pulmonary artery was reconstructed with a xenopericardial patch.

CONCLUSION

In the presented case, it was possible to demonstrate a late manifestation of the Bland-White-Garland syndrome at the age of 43 years. Reconstruction of the coronary bed significantly improved the patient's condition and her quality of life.