title: Anomalous origin of the left coronary artery from the pulmonary artery associated with an accessory atrioventricular pathway and managed successfully with surgical and interventional electrophysiological treatment: a case report.
abstract: BACKGROUND
  The combination of anomalous left coronary artery origin from the pulmonary artery and an accessory pathway has not been reported previously in the medical literature. In medicine, the coexistence of two clinical causes can lead to the same clinical findings, and this can make the researcher's attempt to distinguish between the two of them and, hence, the correct diagnosis and treatment difficult.
  
  
  METHODS
  A six-month-old boy from Pakistan was brought to our hospital with tachypnea and supraventricular tachycardia and, on the basis of echocardiography and multi-slice computed tomography, was diagnosed with an anomalous left coronary artery origin from the pulmonary artery. The presence of an anomalous left coronary artery origin from the pulmonary artery was not initially recognized, and left ventricular dysfunction was considered as a result of supraventricular tachycardia. He underwent direct re-implantation of the left coronary artery to the aorta using the trapdoor flap technique. Recurrent episodes of supraventricular tachycardia resistant to maximal pharmacological treatment occurred post-operatively. A left posterolateral accessory pathway was successfully ablated by using a trans-septal approach.
  
  
  CONCLUSIONS
  It should not be forgotten by anyone that many times in medicine what seems obvious is not correct. It can be difficult to distinguish two clinical entities, and frequently one is considered a result of the other. This is the first report of the coexistence of an anomalous left coronary artery origin from the pulmonary artery and recurrent supraventricular tachycardia due to an accessory pathway in a child that was treated successfully with combined surgical and interventional electrophysiological treatment. This case may represent a first educational step in the field of congenital heart disease, that is, that anomalies such as an anomalous left coronary artery origin from the pulmonary artery may be concealed in a child with other serious cardiac problems, in this case mitral regurgitation, dilation of the left ventricle, and recurrent episodes of tachycardia.
authors.affiliation: Department of Pediatric Cardiology, Onassis Cardiac Surgery Center, Syggrou Aven 356, Athens 176 74, Greece. tsutsi@otenet.gr.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Tsoutsinos
authors.forename: Fotios
authors.initials: F
authors.lastname: Mitropoulos
authors.forename: Christina
authors.initials: C
authors.lastname: Trapali
authors.forename: John
authors.initials: J
authors.lastname: Papagiannis