VALCAPA eT CMd de L`enfant

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Fait clinique
Keywords
Anomalous origin of left
coronary artery from
pulmonary artery, Dilated
cardiomyopath, Child.
Mots-clés
Origine anormale de
l’artère coronaire gauche,
cardiomyopathie dilatée,
enfant.
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Service de cardiologie pédiatrique- hôpital La Rabta- Tunis-Tunisie
Su mm ar y
Anomalous origin of left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital
malformation, most often revealed by severe dilated cardiomyopathy in infants and young children. We
report the case of a 5 year-old girl with dilated cardiomyopathy. The diagnosis of ALCAPA was suspec-
ted thanks to the electrocardiogram and Doppler echocardiography data. The child was successfully
operated on.
Ré su mé
Résumé :
La naissance d’une artère coronaire gauche à partir de l’artère pulmonaire(ALCAPA) est une malforma-
tion congénitale rare, révélée le plus souvent par une cardiomyopathie dilatée sévère chez le nourrisson
et le petit enfant. Nous rapportons le cas d’une fillette de 5 ans suivie pour cardiomyopathie dilatée, chez
qui le diagnostic d’ALCAPA a été suspecté sur les données de l’électrocardiogramme et de l’échocardio-
graphie Doppler. L’enfant a été opérée avec succès de cette malformation grave.
Anomalous origin of left coronary artery from pulmonary
artery, a rare etiology of dilated cardiomyopathy in children.
A case report and revue of literature.
Origine anormale de l’artère coronaire gauche à partir de
l’artère pulmonaire, une étiologie rare de cardiomyopathie
dilatée chez l’enfant. A propos d’un cas et revue de la littérature.
Correspondance
Docteur HAKIM Kaouthar
Service de Cardiologie pédiatrique de l'hôpital la Rabta
1007 Jebbari Tunis
Telephone: [phone]
Fax: [phone]
e-mail: [email protected]
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67

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Figure 1 : Présence d’un aspect QR en latéral (DI, AVL, V5
et V6).
Figure 2 : Flux d’insuffisance mitrale avec aspect
hyperéchogène des piliers.
Figure 3 : Coronaire droite dilatée de naissance et de trajet
normaux
4eme Trimestre 2013
Cardiologie Tunisienne 68
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Hakim K. & al.
4eme Trimestre 2013
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Figure 4 : Visualisation de l’artère coronaire aberrante naissant du tronc de l’artère pulmonaire (indiquée par la flèche) : A : en
bidimensionnel ; B : au Doppler couleur
Figure 5 : Naissance de l’artère coronaire (flèche) à partir du tronc de l’artère pulmonaire
4eme Trimestre 2013
Cardiologie Tunisienne 69

* $( ! ""(
4eme Trimestre 2013
Cardiologie Tunisienne 70
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"M:GM NG> <:NL> <NK:;E> >M KXO>KLB;E> =>
<:K=BHFRHI:MAB> =BE:MX> E: G:BLL:G<> :GHKF:E> => E:
<HKHG:BK> @:N<A> U I:KMBK => Ex:KMYK> INEFHG:BK> =HBM
ZMK>XOHJNX>=>O:GMMHNM><:K=BHFRHI:MAB>=BE:MX> =>
Ex>G?:GM >KM:BGLXEXF>GMLHKB>GM>GMO>KL<>=B:@GHLMB<
+HNLIHNOHGL<BM>KE>L<KBMYK>LXE><MKBJN>L=>'HAGLKN=>
IKXL>GML=:GLGHMK>H;L>KO:MBHGJNB<HGLBLM>GM>G
NG>HG=>.IKH?HG=>FFIKHEHG@X> FL :O><
NG :LI><M ./ =:GL E>L =XKBO:MBHGL E:MXK:E>L >M JNB >LM
:;L>GM> =:GL E> M>KKBMHBK> BG?XKB>NK -HNK
ExX<AH<:K=BH@K:IAB> A:G@ >M EE:=:  HGM XM:;EBL
JN:MK><KBMYK>L2GK:IIHKM=N=B:FYMK>=>E:<HKHG:BK>
LNK <>ENB => Ex:GG>:N :HKMBJN>   NG>
ARI>KX<AH@XGB<BMX =>L IBEB>KL FBMK:NQ NG ?ENQ =HIIE>K
<HNE>NK>MINELXBGO>KLX>M<A>SE>@K:G=>G?:GMNG
?ENQ :;HG=:GM => A:NM> OXEH<BMX :N GBO>:N =N L>IMNF
BGM>KO>GMKB<NE:BK> MXFHB@G:GM =xNG> <BK<NE:MBHG
<HEE:MXK:E>BFIHKM:GM>
)xX<AH<:K=BH@K:IAB> <HNIEX> :N !HIIE>K >LM LN??BL:GM>
IHNK<HG?BKF>KE>=B:@GHLMB<=x) -JN:G=>EE>FHGMK>
<A>SNG>G?:GMIKXL>GM:GMNG><:K=BHFRHI:MAB>=BE:MX>
NG><HKHG:BK>=KHBM>=BE:MX>:LLH<BX>UNG>BGO>KLBHG=N
?ENQ=:GLE:<HKHG:BK>@:N<A>O>KLEx:KMYK>INEFHG:BK>:N
!HIIE>KINELX
!:GL E>L <:L Ha E> =B:@GHLMB< =x) - >LM LNLI><MX
=>O:GM NG> <:K=BHFRHI:MAB> =BE:MX> L:GL IHNOHBK ;B>G
OBLN:EBL>K E: F:E?HKF:MBHG U ExX<AH=HIIE>K =x:NMK>L
>QIEHK:MBHGL LxBFIHL>GM )> <HKHL<:GG>K Lx>LM
E:K@>F>GM LN;LMBMNX U Ex:G@BH@K:IAB> <HKHG:BK>
<HGO>GMBHGG>EE> >M <HGLMBMN> => GHL CHNKL NG FHR>G
=B:@GHLMB<L>GLB;E>>MI>NBGO:LB?
)> MK:BM>F>GM => Ex) - >LM <ABKNK@B<:E )xBG=B<:MBHG
HIXK:MHBK> =HBM ZMK> IHLX> =YL JN> E> =B:@GHLMB< >LM
<HG?BKFX >M E: KXI:K:MBHG =HBM ZMK> KX:EBLX> E> IENL
IKX<H<>F>GMIHLLB;E>-ENLB>NKLM><AGBJN>L<ABKNK@B<:E>L
HGM XMX =X<KBM>L ): KXBFIE:GM:MBHG =BK><M> => E:
<HKHG:BK> @:N<A> LNK Ex:HKM> IK:MBJNX> <A>S GHMK>
I:MB>GM>=>F>NK>E:M><AGBJN>E:IENLNMBEBLX>:O><E>L
F>BEE>NKL KXLNEM:ML  ): M><AGBJN> => 1:D>N<AB JNB
<HGLBLM>U<HGG><M>KE:<HKHG:BK>@:N<A>:;>KK:GM>LNK
Ex:HKM> OB: NG MNGG>E BGMK:INEFHG:BK> >LM BG=BJNX> :NQ
<:LHaE:KXBFIE:GM:MBHG=BK><M>=>E:<HKHG:BK>@:N<A>
LNKEx:HKM>>LM=B??B<BE>=N?:BM=xNG>EHG@N>NKBG:=XJN:M>
=>Ex:KMYK><HKHG:BK>
):GX<>LLBMX=xNG@>LM>:LLH<BXLNKE:O:EO>FBMK:E>:XMX
EHG@M>FIL =BL<NMX> -ENLB>NKL XMN=>L HGM FHGMKX
JNx:IKYLKXBFIE:GM:MBHG<HKHG:BK>ExBGLN??BL:G<>FBMK:E>
K>LM> LM:;E> =:GL  U   =>L <:L >M JNxNG>
:FXEBHK:MBHG=x:NFHBGLNG@K:=>:XMXGHMX>=:GL
=>L<:L ><B>QIEBJN>Ex:MMBMN=><HGL>KO:MKB<>:=HIMX>
I:KE:IENI:KM=>LXJNBI>LJNBG><HGL>BEE>GM=>KXI:K>K
E: O:EO> JNx>G <:L => ?NBM> F:LLBO> >G IKXL>G<> =>
EXLBHGL BKKXO>KLB;E>L XOB=>GM>L HN LxBE >QBLM> NG
FX<:GBLF> GHG BL<AXFBJN> :LLH<BX "G >??>M E:
KXI:K:MBHG FBMK:E> <A>S Ex>G?:GM CN@X> =XEB<:M> >LM
LHNK<> => IKHEHG@:MBHG => E: =NKX> => E: <BK<NE:MBHG
>QMK:<HKIHK>EE> IHNO:GM GNBK> =:O:GM:@> U NG
O>GMKB<NE> @:N<A> =HGM E: ?HG<MBHG >LM =XCU :EMXKX>
): FHKM:EBMX IKX<H<> O:KB> L>EHG E>L LXKB>L =>  U 
)>LIKBG<BI:E>L<:NL>L=>=X<YLXM:GM
E>L:KKARMAFB>LO>GMKB<NE:BK>L>ME>;:L=X;BM<:K=B:JN>
)>L ?:<M>NKL => KBLJN> => FHKM:EBMX IKX<H<> LHGM E:
=RL?HG<MBHG O>GMKB<NE:BK> @:N<A> IKXHIXK:MHBK> LXOYK>
:O>< NG> ?K:<MBHG =xXC><MBHG BG?XKB>NK> U  >M E>
K><HNKLUExEx:LLBLM:G<>O>GMKB<NE:BK>FX<:GBJN>>GIHLM
HIXK:MHBK>):O:E>NKIKHGHLMBJN>=>E:LXOXKBMX=>Ex&*
IKXHIXK:MHBK>>LM<HGMKHO>KLX>
)>K><HNKLEx:LLBLM:G<>O>GMKB<NE:BK>>GIHLMHIXK:MHBK>

Hakim K. & al.
4eme Trimestre 2013
>LMGX<>LL:BK>=:GLU=>L<:LL>EHGE>LLXKB>L
 )>L ?:<M>NKL IKX=B<MB?L => K><HNKL U Ex:LLBLM:G<>
O>GMKB<NE:BK> FX<:GBJN> >G IHLM HIXK:MHBK> LHGM  E:
=RL?HG<MBHG 3$ IKXHIXK:MHBK> LXOYK> ExXM:M <EBGBJN>
<KBMBJN>IKXHIXK:MHBK>I:MB>GMLLHNLBGHMKHI>LIHLBMB?L
>ME:=NKX> IKHEHG@X> =>E:<BK<NE:MBHG >QMK:<HKIHK>EE>
): KX<NIXK:MBHG => E: ?HG<MBHG =N O>GMKB<NE> @:N<A>
:IKYL K>O:L<NE:KBL:MBHG >LM E: KY@E> "EE> >LM H;L>KOX>
=:GLNG=XE:BJNBO:KB>L>EHGExV@>HIXK:MHBK> >=XE:B
G>=XI:LL>I:LE>LFHBLLBE>F:E:=>>LMHIXKX:O:GM
ExV@>=xNG:G>MI>NM:EE>KE><:LX<AX:GMCNLJNxU:GL
-HNKGHMK>F:E:=>GHNLG>=BLIHLHGL I:L >G<HK> =xNG
K><NE LN??BL:GM +HNL IKX<HGBLHGL NG> LNKO>BEE:G<>
<EBGBJN> >M X<AH@K:IABJN> KX@NEBYK> IHNK XO:EN>K E:
?HG<MBHGO>GMKB<NE:BK>>MExXOHENMBHG=>E:?NBM>FBMK:E>
)>IKHGHLMB<UFHR>G>MEHG@M>KF>L>LM;HGF:BLBEK>LM>
<HG=BMBHGGXI:KE>KBLJN>=>FHKMLN;BM>I:KMKHN;E>L=N
KRMAF>BG<BM:GMUNG>LNKO>BEE:G<>K:IIKH<AX>I:K%HEM>K
KRMAFBJN> I:KMB<NEBYK>F>GM :N <HNKL => E: IXKBH=> =>
KX<NIXK:MBHG=>E:?HG<MBHGO>GMKB<NE:BK>@:N<A>
):LNKOB>U:GL=XI:LL>=:GLE:IENI:KM=>L
LXKB>L
!>L KXBGM>KO>GMBHGL U FHR>G >M U EHG@ M>KF> HGM XMX
K:IIHKMX>L=:GLU=>L<:L&ELx:@BM=:GL
E: IENI:KM =>L <:L => KXBGM>KO>GMBHGL IHNK BGLN??BL:G<>
FBMK:E>IENLK:K>F>GM=xNG>:G@BHIE:LMB><ABKNK@B<:E>=>
E:<HKHG:BK>@:N<A>KXBFIE:GMX>HN=xNGIHGM:@>:HKMH
<HKHG:BK>
conclusIon
):G:BLL:G<> :GHKF:E>=xNG> <HKHG:BK>@:N<A> UI:KMBK
=> Ex:KMYK> INEFHG:BK> >LM NG> <:NL> K:K> =>
<:K=BHFRHI:MAB> =BE:MX> <A>S Ex>G?:GM !N ?:BM => E:
KXO>KLB;BEBMX => E: <:K=BHFRHI:MAB> :IKYL MK:BM>F>GM
<ABKNK@B<:E>EE>=HBMZMK>LRLMXF:MBJN>F>GMXOHJNX>>M
K><A>K<AX> =:GL E> <:=K> =N ;BE:G XMBHEH@BJN>
)xX<AH<:K=BH@K:IAB>!HIIE>KI>KF>ME>IENLLHNO>GM=>
?:BK> E> =B:@GHLMB< !:GL E>L :NMK>L <:L <x>LM E>
<HKHL<:GG>K HN E: <HKHG:KH@K:IAB> JNB I>KF>MM>GM =>
K><HGG:BMK><>MM>:GHF:EB>):KXBFIE:GM:MBHG<HKHG:BK>
=BK><M> LNK Ex:HKM> >LM E: M><AGBJN> => KX?XK>G<> 2G
@>LM> LNK E: O:EO> FBMK:E> Gx>LM BG=BJNX JNx>G <:L =>
?NBM>F:LLBO>HN LxBE >QBLM>NG>:NMK><:NL> :LLH<BX> U
Ex&* )> IKHGHLMB< EHBGM:BG >LM LHNO>GM ;HG F:BL NG>
LNKO>BEE:G<> <EBGBJN> X<AH@K:IABJN> >M KRMAFBJN> >LM
BG=BLI>GL:;E>
reFerences
 :LM>G:=:/'HG:L/*:R>KL'">M:E HKHG:KR:KM>KB>L
:GHF:EB>L :K=B:< LNK@>KR H? MA> G>HG:M> :G= BG?:GM
-ABE:=>EIAB:-0:NG=>KLs
 !:OBL' ><<ABG#'-HKMF:G**:CHK<HKHG:KR:KM>KR
:GHF:EB>L BG I>=B:MKB< IHINE:MBHG &G<B=>G<> :G= <EBGB<:E
BFIHKM:G<>'F HEE :K=BHE
 KHHDL%1PH<:L>LH?:G:;GHKF:E<HKHG:KR:KM>KRH?MA>
A>:KM :KBLBG@ ?KHF MA> INEFHG:KR :KM>KR PBMA LHF>
K>F:KDL NIHG MA> >??><M H? MABL :GHF:ER BG IKH=N<BG@
<BK<HB= =BE:MBHG H? MA> O>LL>EL':G:M-ARLBHE  
 !:AE>$#B:G>")BG=;>K@%)) -:IHLLB;E>K>:LHG
?HKFBMK:EBGLN??B<B>G<R:G=A>:KM?:BENK>BGRHNG@I:MB>GML
0<:G= :K=BHO:L<'
 4>LL>EAH>?M%#:P<>MM'0'HAGLHGGHF:EHNLHKB@BGH?
MA> E>?M <HKHG:KR :KM>KR ?KHF MA> INEFHG:KR MKNGD &ML
<EBGB<:ELI><MKNFI:MAHEH@R:G=IARLBHI:MAHEH@R;:L>=HG
:K>OB>PH?<:L>LPBMAL>O>G?NKMA>K<:L>L BK<NE:MBHG
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4eme Trimestre 2013
Cardiologie Tunisienne 71