Intra coronary thrombolytic injection during primary PCI in 32 year old man with (ALCAPA)

Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a congenital heart defect which is associated with early infant mortality and adult sudden death A 32-year-old athlete man who was known case of ALCAPA since 2 years ago and has been underwent required surgery with detaching the left coronary artery from pulmonary artery and suturing it into the aorta with no medicine ,presented by acute chest pain and Inf RV STEMI . the patient transferred to catheterization laboratory immediately for primary percutaneous coronary intervention (PCI). Emergent coronary angiography demonstrated significant left main artery dilatation with acceptable blood flow and severe right coronary artery aneurysm with full obstruction started at mid part. Considering massive thrombosis in RCA and disability of thrombosuction to restoring the flow, slow intracoronary injection of 30mg Alteplase has been used. After 20 minutes of thrombolytic intracoronary injection, proportional reduction of obstruction and acceptable blood flow in RCA proved, likewise the patient became symptoms free. .In rare cases during primary PCI we can use intracoronary thrombolytic injection for reforming blood flow.

Keywords:

ALCAPA , thrombosis , RV aneurism , myocardial infarction ,