Anomalous Left Coronary Artery Connected to the Pulmonary Artery in a 15-Year-Old Girl: Case Report and Discussion on Secondary Prevention of Sudden Death.

Background. Anomalous left coronary artery connected to the pulmonary artery (ALCAPA) is a rare congenital heart disease. Adaptive development of sufficient heterocoronary collaterality in the newborn may allow survival to a later age. In older children or adults, malignant ventricular arrhythmias can reveal the disease. Case Report. A 15-year-old girl was referred to the local hospital after a resuscitated out-of-hospital cardiac arrest. CT scan and coronary angiography revealed an ALCAPA. Direct aortic reimplantation of the left coronary artery was performed. Postoperative ECG monitoring showed short episodes of nonsustained ventricular tachycardia. Transthoracic echocardiography and cardiac MRI revealed subendocardial fibrosis of the anterolateral papillary muscle. Beta-blockade therapy was initiated at first intention. After hospital discharge, the patient reported several fainting without loss of consciousness. Considering sudden death nonrelated to effort, episodes of nonsustained ventricular tachycardia, and areas of myocardial fibrosis, the patient underwent subcutaneous cardioverter-defibrillator implantation. 6-month follow-up is satisfactory without clinical or rhythmic abnormalities. Discussion. Indication for surgical correction of ALCAPA is well defined, but rhythmic secondary prevention after resuscitated cardiac arrest is less consensual. Cardiac MRI is an essential tool in the identification of a potential rhythmic substrate and should be taken into account in the discussion of a preventive cardioverter-defibrillator implantation.

[Acute obstructive kidney failure during sulfadiazine treatment]. / Insuffisance rénale aiguë obstructive lors d'un traitement par sulfadiazine.

INTRODUCTION: Acute obstructive kidney failure can occur during sulfadiazine treatment of cerebral toxoplasmosis in immunocompromised patients. CASE: Six days after the patient began sulfadiazine treatment for toxoplasmosis, he developed low back pain radiating into the abdomen and kidney failure with obstructive uropathy, followed by anuria. Abdominal computed tomography found bilateral pyelocaliceal distention. Six hours after a hemodialysis session, the pain stopped abruptly and abundant diuresis resumed. DISCUSSION: During acute renal failure due to sulfadiazine, simply stopping the drug treatment does not suffice. The massive alkalinization induced by hemodialysis, however, is effective.