Discussion

Anomalies of the coronary arteries are a very rare condition in the paediatric population, seen in 0.2–1.4% of in the general population. ^{Reference Grabowski, Karolczak, Zacharska-Kokot, Madry and Pajak1} Among the abnormal origin of coronary arteries from pulmonary artery, anomalous single trunk coronary artery from the pulmonary artery is the least seen group in which both left and right coronary artery originate from pulmonary artery as a single ostium. ^{Reference Heifetz, Robinowitz, Mueller and Virmani2,Reference Januszewska, Kehl and Malec3} Anomalous origin of coronary arteries from pulmonary arteries are usually sporadic anomaly, but may present with other congenital heart defects as single ventricle physiology, atrial septal defects, ventricular septal defects, coarctation of aorta, tetralogy of Fallot, or pulmonary atresia. ^{Reference Heifetz, Robinowitz, Mueller and Virmani2–Reference Kayalar, Burkhart, Dearani, Cetta and Schaff5} It may be asymptomatic or presenting with poor feeding and insufficiency in weight gain in the first days of neonatal period. ^{Reference Machovec, Taicher, Jaquiss and Hill6} Symptoms can be seen with pulmonary vascular resistance fall with the increase in shunt to the lung and cause of coronary stealing. ^{Reference Machovec, Taicher, Jaquiss and Hill6} Anomalous single coronary artery from the pulmonary artery causes myocardial ischemia, ventricle systolic dysfunction, arrhythmia, and sudden cardiac death in infancy. Association with another lesions affects the onset time of symptoms, survive, and prognosis of patients. ^{Reference Heifetz, Robinowitz, Mueller and Virmani2,Reference Santoro, di Carlo and Carotti4} To see the findings of impaired ventricular systolic function, cardiomegaly and various degree of atrioventricular valve failure in the echocardiography and anomalous coronary artery from the pulmonary artery should be considered in the neonatal periods. ^{Reference Karimi, Hulsebus and Lutin7} CT angiography, MRI, or coronary angiography should be performed in cases suspected of anomalous coronary artery from the pulmonary artery with echocardiography. ^{Reference Grabowski, Karolczak, Zacharska-Kokot, Madry and Pajak1} Coronary arteries cannot be visualised with aortic root contrast injection in the coronary angiography, and anomalous single coronary artery from the pulmonary artery is diagnosed when a single orifice of coronary arteries is seen with the pulmonary artery contrast injection. Urgent surgical coronary artery reimplantation should be planned immediately after diagnosis. Prostaglandin and inotropic support may be initiated for the stabilisation of patient in the neonatal period until surgery. ^{Reference Karimi, Hulsebus and Lutin7} In the follow-up period after surgical correction, stenosis or thrombotic problems should be evaluated. ^{Reference Grabowski, Karolczak, Zacharska-Kokot, Madry and Pajak1}

In our patient, we suspected coronary anomaly on echocardiographic findings and decided to perform coronary angiography for definite diagnosis. After angiography proven diagnosis, she underwent surgery, but due to late presentation and impaired systolic function, extracorporeal membrane oxygenation was needed after the surgical correction. These coronary anomalies are known to have higher mortality rates inspite of advanced surgical techniques and procedures. Unfortunately, our patient showed no recovery and died on day 49 of the extracorporeal membrane oxygenation.