Cardiac arrest is rarely seen in children and teenagers. We present a 12-year old girl with cardiac arrest following myocardial infarction, that required prolonged cardiac massage and extracorporeal-membranous-oxygenation (ECMO). At coronary angiography the left main coronary artery (LMCA) was stented for a suspected coronary dissection. The contraction of the heart improved and the ECMO-treatment was discontinued a week later. The patient was discharged home, but six months later a coronary artery bypass surgery was performed for in-stent restenosis. Further work-up with computed tomography (CT) showed that the LMCA originated from the right aortic sinus instead of the the left one. This case demonstrates how life threatening myocardial infarction can be caused by coronary artery anomalies.

Valdimarsson VTh¹, Hirlekar G⁵, Olafsson O⁵, Oskarsson G², Helgason H², Sigurdsson SE⁵, Tomasdottir H¹, Eyjolfsson K³, Gudbjartsson T^4,6

¹Departments of Anesthesia and Intensive Care, ²Pediatrics, ³Cardiology and ⁴Cardiothoracic surgery, Landspitali University Hospital, ⁵Department of Anesthesia and Intensive Care, Akureyri Hospital, ⁶Faculty of Medicine, University of Iceland.

Figure 1. Chest X-ray at admission in Akureyri Hospital.

Figure 2. Serum Troponin-T mesurement (ug/L) (normal value < 0,01 ug/L).

Figure 3. An EKG 24 hours after beginning of symptoms.

Figure 4. Emergency coronary angiography 24 hours after first symptoms. A 10 mm stenosis in the main stem of the left coronary artery can be seen (arrow).

Figure 5. A CT scan showing anomalous origin of the left main coronary artery (arrow) from the right aortic sinus, also showing the course of the vessel between the aorta and pulmonary trunk.